IntroductionBreast cancer remains a leading cause of cancer-related morbidity and mortality in sub-Saharan Africa, with Uganda experiencing a reported 5% annual increase in cases. Alarmingly, 87% of women in Uganda present with advanced-stage disease that is less responsive to treatment, contributing to the region's disproportionately low survival rate. Early breast cancer detection will be the fundamental intervention to reverse the mortality resulting from breast cancer in Uganda. This study aims to enhance breast cancer screening and early detection in Ugandan women who are at risk through innovative use of quantitative MRI to differentiate between benign and malignant breast lesions for women at risk.MethodsThe study prospectively recruited women at risk of breast cancer who underwent breast ultrafast DCE-MRI from July 2023 to April 2024. A 3.0-T MRI system with a16 channel breast dedicated coil was used with scan durations of up to 10 min. The T1 weighted pre-contrast, T1 weighted post-contrast, T1 weighted dynamic subtracted and Maximum Intensity projection (MIP) sequences were acquired and the histology blinded pharmacokinetic analysis for the breast lesion was done. The initial area under the curve in 30 s after contrast injection (iAUC30), MaxSlope, K(trans), BAT, and υ(e) were calculated and used to assess the diagnostic performance.ResultsA total of 52 women were recruited and imaged and 36 lesions were found. Unlike the MaxSlope, K(trans), BAT and υ(e) the iAUC30 values exhibited significant differences between benign and malignant lesions with a P-value <.005 and the area under the ROC curve (iAUC30) was 0.9147. The sensitivity, specificity, PPV and NPV of MRI using histology as the gold standard at 95% confidence interval were 70%, 100%, 100% and 73.9% respectively.ConclusionsAbbreviated DCE-MRI protocols with quantitative analysis can effectively differentiate malignant from benign breast lesions with improved compliance and can be adopted as a model of breast cancer screening and early detection for women at risk.

BACKGROUND: As the World Health Organization (WHO) currently recommends that children be protected against 11 different pathogens, it is becoming increasingly necessary to administer multiple injectable vaccines during a single immunization visit. In this study we assess Gambian healthcare providers' and infant caregivers' attitudes and practices related to the administration of multiple injectable vaccines to a child at a single immunization visit before and after the 2015 introduction of inactivated polio vaccine (IPV). IPV introduction increased the number of injectable vaccines recommended for the 4-month immunization visit from two to three in The Gambia. METHODS: We conducted a cross-sectional questionnaire-based survey before and after the introduction of IPV at 4months of age in a representative sample of all health facilities providing immunizations in The Gambia. Healthcare providers who administer vaccines at the selected health facilities and caregivers who brought infants for their 4month immunization visit were surveyed. FINDINGS: Prior to IPV introduction, 9.9% of healthcare providers and 35.7% of infant caregivers expressed concern about a child receiving more than 2 injections in a single visit. Nevertheless, 98.8% and 90.9% of infants received all required vaccinations for the visit before and after IPV introduction, respectively. The only reason why vaccines were not received was vaccine stock-outs. Infant caregivers generally agreed that vaccinators could be trusted to provide accurate information regarding the number of vaccines that a child needed. CONCLUSION: Healthcare providers and infant caregivers in this resource limited setting accepted an increase in the number of injectable vaccines administered at a single visit even though some expressed concerns about the increase.