Journal of Global Medicine

Mitigating the healthcare exodus: pathways to retention and brain gain in Nigeria

2026-04-01T08:12:01+00:00

The ongoing emigration of healthcare professionals from Nigeria – commonly referred to as ‘brain drain’ or the ‘Japa syndrome’ – poses a significant threat to the nation’s public health infrastructure and broader developmental objectives. This perspective article contends that, while the immediate effects of this phenomenon are profoundly adverse, there is a critical need for a paradigm shift: from perceiving brain drain solely as a detrimental loss to strategically reimagining it as an opportunity for ‘brain gain’. Drawing on findings from an online survey of 155 members of the Ibadan College of Medicine Alumni Association (ICOMAA Worldwide), this perspective article examines the multifactorial drivers of health professional migration and articulates actionable, evidence-based recommendations for the Nigerian government and healthcare stakeholders. These recommendations focus on enhancing working conditions, cultivating innovative frameworks for diaspora engagement, and prioritising sustained investment in health workforce development. Ultimately, the article advocates for policies that not only stem the outflow of talent but also leverage the expertise, resources, and networks of the Nigerian health diaspora to strengthen the domestic healthcare system.

Living with Cancer

2026-01-17T00:12:12+00:00

Your Health As The Climate Changes: Death and Disease on a Warming Planet

2026-02-08T10:30:12+00:00

Global Health is Local Health: Why we should care about Haiti

2026-05-26T11:33:48+00:00

Following the aftermath of Hurricane Melissa in 2025, the people of Haiti suffered immensely. Although the direct impact of the storm was devastating, it was truly the backdrop of an ongoing humanitarian crisis that primed Haiti for this disaster. With many worldwide unaware of the magnitude of this humanitarian crisis, this article aims to explore the details surrounding a recent mission trip to supply medical aid to children and adults suffering from ailments related to the storm. In doing so, an ideological framework is proposed to guide readers towards the quintessential question - "why should those unaffected care?"

Selective extrinsic coagulation pathway amplification with preserved intrinsic function in normal singleton pregnancy: a cross-sectional study with trimester-specific gestational reference intervals from a Nigerian Obstetric Cohort

2026-08-04T11:20:26+00:00

Background: Normal pregnancy induces a procoagulant haemostatic transformation through differential upregulation of coagulation factors and suppression of fibrinolysis. The extrinsic coagulation pathway, driven by tissue factor (TF) and factor VII, is theorised to be preferentially amplified during gestation, while the intrinsic (contact-activation) pathway remains functionally stable. However, direct empirical evidence from sub-Saharan African obstetric populations is absent, and population-specific gestational coagulation reference intervals are unavailable for Nigerian clinical practice.

Objectives: This study aimed to test the hypothesis that the extrinsic coagulation pathway is selectively amplified, while the intrinsic pathway remains stable, during normal singleton pregnancy in a Nigerian obstetric cohort; and to generate trimester-stratified gestational reference intervals for prothrombin time (PT), international normalised ratio (INR), and activated partial thromboplastin time (APTT).

Methods: A cross-sectional case-control study was conducted at three public tertiary hospitals in Ibadan, Oyo State, Nigeria. A total of 266 participants were enrolled: 216 healthy singleton pregnant women (56 in the first trimester [T1], 82 in T2, 78 in T3) and 50 non-pregnant controls. PT and APTT were measured by the manual water-bath tilting-tube method; INR was derived from the PT ratio. One-way analysis of variance with post hoc Tukey’s honestly significant difference test was applied; results are reported in accordance with the STROBE checklist for observational studies.

Results: PT was significantly shorter in all trimester groups versus controls (F_3,262 = 4.065, P = 0.008; η² = 0.044): T1: 14.37 ± 1.22 s; T2: 14.64 ± 1.31 s; T3: 14.20 ± 1.31 s; controls: 14.93 ± 0.96 s. INR was similarly lower in pregnant groups (F_3,262 = 4.894, P = 0.003; η² = 0.053). In contrast, APTT did not differ significantly across groups (F_3,262 = 0.558, P = 0.643; η² = 0.006). Trimester-specific gestational reference intervals for PT (11.6–16.8 s at T3) were substantially below the non-pregnant lower limit of 13.0 s.

Conclusions: Normal pregnancy in a Nigerian population is characterised by selective amplification of the extrinsic coagulation pathway with complete preservation of intrinsic pathway function, consistent with TF-mediated procoagulant activation as the dominant gestational haemostatic mechanism. Locally derived gestational reference intervals differ substantially from non-pregnant values; their adoption would reduce misclassification of physiological coagulation changes in antenatal haemostasis monitoring.

Rising prostate cancer incidence in Africa: socioeconomic impact implications and 25-year projection

2026-03-11T13:38:42+00:00

Background: Prostate cancer is the most common male malignancy globally, with a disproportionately high burden in Africa and negative quality of life and economic consequences, as well as premature mortality.

Methods: This study uses Global Cancer Observatory 2022 data on prostate cancer (International classification of diseases [ICD]-10 C61) from 48 African countries to estimate incidence and mortality and to project future trends to 2050. Incidence and mortality predictions were based on constant 2022 national rates applied to population growth projections. Economic productivity losses were calculated using International Labour Organisation statistics and remaining years of productive life before age 65.

Results: In 2022, there were an estimated 103,050 new prostate cancer cases and 58,890 deaths in Africa, accounting for 8.7% of all cancers. Age-standardised incidence and mortality rates were 30.3 and 17.3 per 100,000, respectively, with the highest rates observed in Southern, Middle, and West Africa. By 2050, prostate cancer cases are projected to increase by 173.7%, reaching 282,005 new cases annually, with the steepest rise in countries such as Equatorial Guinea, Zambia, and Cape Verde. Prostate cancer was among the top cancers contributing to economic productivity loss in four of five African regions, with West Africa recording an average of 32.2 years of productive life lost compared to a world average of 9.4 years.

Conclusions: Prostate cancer burden in Africa is expected to nearly triple by 2050, driven by demographic expansion and ageing. Strengthening early detection, access to care, and targeted health policies are required to address this growing challenge and mitigate productivity losses.

The metal fingerprint of preeclampsia: evaluating the copper-to-zinc ratio in Nigerian pregnant mothers

2026-03-23T09:50:30+00:00

Background: Preeclampsia poses serious medical risks to pregnant women in the world, especially those in developing countries like Nigeria. This study aimed to identify specific levels of zinc, copper, and selenium and to determine the relationship between the copper-to-zinc ratio and preeclampsia in pregnant mothers.

Materials and Methods: Serum levels of zinc, copper, and selenium were analysed using atomic absorption spectrophotometry (AAS). The copper-to-zinc ratio was calculated, and a paired t-test was used to analyse the data; P-values less than 0.05 were considered statistically significant.

Results: Serum levels of zinc and selenium in pregnant women with preeclampsia were significantly lower (P < 0.001) than those of the normotensive pregnant women. Conversely, the serum copper level and copper-to-zinc ratio of pregnant women with preeclampsia were markedly higher (P < 0.001) when compared to those of the normotensive pregnant women. After adjusting for age and body mass index (BMI), the mean Cu/Zn ratio was 2.86 (95% confidence interval of 2.85–2.87, P < 0.01) and remained independently associated with pre-eclampsia in a multivariate regression. The Area Under the Receiver Operating Characteristic curve was excellent at 0.9.

Conclusion: The findings provide evidence of an imbalance in essential trace elements, resulting in a significantly elevated Cu/Zn ratio, which could serve as a metal fingerprint linked to preeclampsia in the examined group of Nigerian mothers. The finding is promising as a novel, cost-effective, and easily measurable biomarker for risk evaluation of preeclampsia in resource-limited settings.

Modulation of nitric oxide synthase activity by Burantashi (pausinystalia yohimbe) extract in Wistar rats

2026-03-09T03:55:54+00:00

Introduction: Yohimbine-containing herbs (pausinystalia yohimbe, ‘Burantashi’) are traditionally used as aphrodisiacs and may alter nitric oxide synthase (NOS) pathways. NOS is essential for nitric oxide (NO) generation, which facilitates penile smooth muscle relaxation and vasodilation.

Aim and objectives: To examine the impact of sildenafil and the methanolic stem-bark extract of pausinystalia yohimbe (Burantashi) on NOS mRNA expression in male Wistar rats. The goals were to: (1) give graded extract dosages for 28 days; (2) measure NOS gene expression using semi-quantitative densitometry and RT-PCR; and (3) compare expression between groups.

Materials and methods: For 28 days, 25 adult male Wistar rats (n = 5 per group) were given either Burantashi extract (50, 100, or 200 mg/kg), sildenafil (5 mg/kg), or distilled water (control). Following euthanasia, NOS PCR was performed using agarose gel electrophoresis, and blood/tissue RNA was collected and reverse-transcribed. Tukey’s post hoc test was used to analyse the results of a one-way analysis of variance (ANOVA).

Results: Comparing the Burantashi-treated groups to the control, semi-quantitative densitometry showed dose-dependent elevation of NOS mRNA; sildenafil induced a strong upregulation. One-way ANOVA F(4,20) p < 0.001; Tukey’s post hoc: sildenafil and 200 mg significantly higher versus control, p < 0.01) showed the following representative (reconstructed) fold-change in NOS expression (mean ± standard error of mean) normalised to control (1.00): control 1.00 ± 0.05, sildenafil 2.10 ± 0.12, Burantashi 50 mg/kg 1.25 ± 0.08, 100 mg/kg 1.78 ± 0.09, and 200 mg/kg 2.45 ± 0.11).

Conclusion: In male Wistar rats, burantashi methanolic extract dose-dependently increases NOS gene expression, indicating that increased NO production is a likely explanation for its traditional aphrodisiac usage. The source data showed no concurrent rise in serum testosterone. Quantifying functional NO generation, hemodynamic outcomes, and safety will require additional effort.

The neglected stepchild at risk: reimagining global surgery of shifting priorities

2026-05-22T08:03:36+00:00

The graveyard of donated equipment: shifting from capital expenditure to value-based care in African health systems

2026-08-07T20:20:21+00:00

Dr Eugene Braunwald (1929–2026) – Modern Father of Cardiology – goodnight

2026-06-01T00:27:09+00:00

Dr Eugene Braunwald was the Hersey Professor of Medicine and Chairman of the Department of Medicine at Brigham and Women’s Hospital and Harvard Medical School. During my fellowship at Harvard in the 1990s, he was not only my Chairman but also a profoundly influential mentor.

Born on August 15, 1929, in Austria, Dr Braunwald fled Nazi-occupied Europe with his family and arrived in the United States as a refugee. From these humble and perilous beginnings, he rose to extraordinary prominence in cardiovascular medicine. He passed away on April 22, 2026, at the age of 96.

At the time of his death, Dr Braunwald had authored more than 1,800 scientific publications. He was the most cited author in cardiology and among the most-cited scientists worldwide. Notably, he became the first adult cardiologist elected to the United States National Academy of Sciences and was widely regarded as a leading candidate for the Nobel Prize in cardiology. He served as editor of two of the most authoritative medical textbooks: Harrison’s Principles of Internal Medicine and Braunwald’s Heart Disease, both of which remain foundational resources worldwide.

Dr Braunwald earned his medical degree from New York University School of Medicine in 1952, followed by residency training at Johns Hopkins Hospital. He married Nina Starr Braunwald, his medical school classmate and a pioneering cardiac surgeon. Initially drawn to engineering – particularly pumps and magnetism – he ultimately chose cardiology, the medical discipline most closely aligned with those interests. In 1954, he published his first work and continued for the next seven decades. In 1959, alongside Dr Morrow, he described hypertrophic cardiomyopathy as a distinct clinical entity, a condition now known to be associated with ventricular arrhythmias and sudden cardiac death in young athletes. This work contributed to the development of screening strategies in competitive sports.

In 1962, during his tenure at the National Institutes of Health, Dr Braunwald and colleagues introduced the measurement of ejection fraction, now the gold standard for assessing ventricular function and classifying heart failure. By 1970, in collaboration with Dr Pfeffer, he advanced the use of angiotensin-converting enzyme inhibitors in the management of heart failure following myocardial infarction, significantly improving patient outcomes.

Among his most enduring contributions was the concept ‘time is muscle’. Through meticulous experimental work, he demonstrated that myocardial infarction evolves over hours rather than occurring instantaneously. This insight established the critical importance of early reperfusion in salvaging ischemic myocardium and reducing mortality. In 1984, he founded the Thrombolysis in Myocardial Infarction (TIMI) Study Group at the Brigham, which has led more than 60 landmark clinical trials. These investigations were instrumental in the development of thrombolytic therapy, early reperfusion strategies, and contemporary interventional approaches, including stent-based treatments.

Over the course of his career, such advances transformed heart disease from a frequently fatal condition into a largely manageable chronic illness. Dr. Braunwald once predicted that within 50 years, heart disease could be significantly controlled and potentially displaced as the leading cause of death. Reflecting on his remarkable journey, he stated, ‘I was in the right place at the right time, with the right collaborators, the right mentors and mentees’. Yet beyond his scientific achievements, he took the greatest pride in the countless individuals he mentored and the lives he impacted.

Abraham Ariyo
Dr. Abraham Ariyo is an Interventional Cardiologist at Baylor
Scott & White Health and the author of The Heart Chronicles.