Population health outcomes in Nigeria compared with other west African countries, 1998-2019: a systematic analysis for the Global Burden of Disease Study.

BACKGROUND: Population-level health and mortality data are crucial for evidence-informed policy but scarce in Nigeria. To fill this gap, we undertook a comprehensive assessment of the burden of disease in Nigeria and compared outcomes to other west African countries. METHODS: In this systematic analysis, using data and results of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019, we analysed patterns of mortality, years of life lost (YLLs), years lived with disability (YLDs), life expectancy, healthy life expectancy (HALE), and health system coverage for Nigeria and 15 other west African countries by gender in 1998 and 2019. Estimates of all-age and age-standardised disability-adjusted life-years for 369 diseases and injuries and 87 risk factors are presented for Nigeria. Health expenditure per person and gross domestic product were extracted from the World Bank repository. FINDINGS: Between 1998 and 2019, life expectancy and HALE increased in Nigeria by 18% to 64·3 years (95% uncertainty interval [UI] 62·2-66·6), mortality reduced for all age groups for both male and female individuals, and health expenditure per person increased from the 11th to third highest in west Africa by 2018 (US$18·6 in 2001 to $83·75 in 2018). Nonetheless, relative outcomes remained poor; Nigeria ranked sixth in west Africa for age-standardised mortality, seventh for HALE, tenth for YLLs, 12th for health system coverage, and 14th for YLDs in 2019. Malaria (5176·3 YLLs per 100 000 people, 95% UI 2464·0-9591·1) and neonatal disorders (4818·8 YLLs per 100 000, 3865·9-6064·2) were the leading causes of YLLs in Nigeria in 2019. Nigeria had the fourth-highest under-five mortality rate for male individuals (2491·8 deaths per 100 000, 95% UI 1986·1-3140·1) and female individuals (2117·7 deaths per 100 000, 1756·7-2569·1), but among the lowest mortality for men older than 55 years. There was evidence of a growing non-communicable disease burden facing older Nigerians. INTERPRETATION: Health outcomes remain poor in Nigeria despite higher expenditure since 2001. Better outcomes in countries with equivalent or lower health expenditure suggest health system strengthening and targeted intervention to address unsafe water sources, poor sanitation, malnutrition, and exposure to air pollution could substantially improve population health. FUNDING: The Bill & Melinda Gates Foundation.

Factors associated with hypertension among adults in high burden kidney disease areas of Jigawa State, Nigeria: A cross-sectional survey.

Background: Hypertension is the leading risk factor for preventable cardiovascular-related complications and mortalities worldwide. Materials and Methods: A cross-sectional survey was conducted to assess the prevalence and factors associated with hypertension among 361 adults from four local government areas (LGAs) of Jigawa state identified to have high burden of kidney diseases. The Modified WHO STEPS questionnaire and multi-stage sampling technique were employed and data were analysed using IBM SPSS version 22.0. Results: The age of the respondents ranged from 18 to 102 years with a median of 45 (interquartile range = 30-80) years. More than a quarter (34.9%) of the respondents were unemployed. Few reported history of alcohol ingestion (0.8%) and cigarette smoking (1.1%). The prevalence of systolic hypertension was 116 (32.1%), while that of diastolic hypertension was 133 (36.8%). Jahun LGA had higher cases (36.7%) of systolic hypertension, whereas Dutse LGA had higher cases (47.8%) of diastolic hypertension. Systolic hypertension was significantly higher (P < 0.001) among those >35 years of age. The odds of developing systolic hypertension were significantly lower among those between the ages of 18 and 35 years, and those between the ages of 18 and 35 years were less likely to have systolic hypertension than those above the age of 35 years (adjusted odds ratio = 9.0; 95% confidence interval = 4.6-17.6). Similarly, those who reported family history of diabetes and hypertension (P < 0.001) had a significantly higher proportion of systolic hypertension. Conclusions: The prevalence of hypertension was alarming in the high burden kidney disease areas. The government should develop a sustainable model for the mass community screening of risk factors and community-based health insurance for the effective management of all identified cases.

Burden, socio-demographic and other risk factors associated with haemodialysis in North-west Nigeria: A retrospective multicentre analysis.

Background: Kidney diseases requiring haemodialysis are becoming an emerging public health problem. This study aimed to determine the burden, socio-demographic and other risk factors associated with haemodialysis in Northwest Nigeria. Methodology: The study was a retrospective multicentre review of secondary data from the dialysis centres of public hospitals in northwestern Nigeria. Risk factors for renal failure were examined in 1329 patients who were enrolled for haemodialysis between 2019 and 2022 in the four public dialysis centres in Kano and Jigawa state. Data were analysed using IBM SPSS Statistics for Windows, version 22.0, with statistical significance set at P ≤ 0.05. Results: The minimum age of the patients was 2 years and the maximum was 100 years with a median of 48 (interquartile range = 31, 60) years. Chronic kidney disease (CKD) was found amongst more than two-thirds 998 (75.1%) of the patients. Up to 51 (3.8%), 62 (4.7%) and 10 (0.8%) were seropositive for HIV, hepatitis B and hepatitis C, respectively. Acute kidney injury (AKI) was significantly higher (67.9%, P < 0.001) amongst patients with post-partum haemorrhage (PPH), and were 24 times more likely to develop AKI when compared with those with no PPH (adjusted odds ratio [aOR] =24, 95% confidence interval [CI] = [13.5-44.5]). CKD was significantly higher amongst patients with hypertension (HTN) (84.9%, P < 0.001), and were 3.2 times more likely to develop CKD compared with non-hypertensives (aOR = 3.2, 95% CI = [2.4-4.1]). Acute on CKD (AOCCKD) was significantly higher amongst patients with chronic glomerulonephritis (CGN) (28.1%, P < 0.001), and were three times more likely to develop AOCCKD than those without CGN (aOR = 3, 95% CI = [2.1-4.2]). Conclusion: PPH was the major reason for AKI related haemodialysis while diabetes and HTN were the major causes of CKD-requiring haemodialysis. CGN was more amongst patients who had dialysis due to acute exacerbation of CKD. The government and relevant stakeholders should ensure a favourable policy for the screening and management of patients.

Prevalence and factors associated with energy drink consumption amongst undergraduate students in Kano, Nigeria.

BACKGROUND: Overconsumption of energy drinks (EDs) is a global public health concern because of its potential health consequence. OBJECTIVES: This study aimed to determine the prevalence and factors associated with ED consumption amongst undergraduate students in Kano, Northwest Nigeria. METHODOLOGY: A descriptive cross-sectional study design was used to study 381 undergraduate students, selected using a two-stage sampling technique. Data were collected using interviewer-administered questionnaires and analysed using SPSS version 22.0 with P ≤ 0.05 considered to be statistically significant. RESULTS: : A total of 381 students were studied. The mean ± standard deviation age of the students was 23.1 ± 3.6 years with male-to-female distribution of about 1:1. Period prevalence of 67.0% within the last 30 days and point prevalence of 23.9% were found. The commonly used ED was Power Horse 44.6%. Up to 59.6% consumed EDs to boost their physical and mental capacity. Odds of ever-consuming EDs were lower in female undergraduates (adjusted odds ratio [aOR]: 0.5, 95% confidence interval [CI]: 0.3-0.7) and higher in Hausa/Fulani ethnic group (aOR: 1.7, 95% CI: 1.04-2.7). Amongst those who were currently consuming EDs, being 24 years or less (aOR: 1.9, 95% CI: 1.04-3.4) and coming from the Hausa/Fulani tribe (aOR: 2.5, 95% CI: 1.4-4.4) were associated with increased consumption. Male undergraduates (aOR: 0.2, 95% CI: 0.1-0.4) and students who were residing on campus were less likely to be current consumers of EDs (aOR: 0.5, 95% CI: 0.3-0.9). CONCLUSION: Consumption of EDs is increasing amongst students and therefore relevant government agencies should ensure regulated advertisement and consumption to avert the health consequences.

Effect of voice reminder on compliance with recommended hand hygiene practise among health-care workers in Kano metropolis.

BACKGROUND: Poor compliance with recommended hand hygiene practise by health-care workers is an emerging public health threat associated with significant morbidity, mortality and spread of multidrug-resistant microorganisms. OBJECTIVE: This study assessed the effect of voice reminder on compliance with recommended hand hygiene practise among the baseline, and post-intervention compliance with recommended hand hygiene among health-care workers using the WHO checklist for observation of 5-moments of hand hygiene of health-care workers in Kano. METHODS: Quasi-experimental study design was used. A total of 408 (204 in each arm) baseline and post-intervention observations were conducted in two hospitals in Kano, selected using a multistage sampling technique. Voice reminders were installed in the intervention hospital, and post-intervention observation was conducted 3 months after introducing a voice reminder. SPSS version 22.0 was used for data analysis. Relationship between variables was tested using χ2 and McNemar's test within the groups at 0.05 α-level of significance. RESULTS: Baseline compliance with hand hygiene in the intervention and control hospitals were 31.4% and 48.0%, respectively. Post-intervention compliance in the intervention and control hospitals were found to be 78.0% and 65.2%, respectively. Voice reminder improved compliance with hand hygiene practise when compared with baseline by +148% (P# = 0.3) in the intervention hospital compared with +36% (P# =0.1) in the control hospital. The differences were not statistically significant post-intervention when compared with the baseline. CONCLUSIONS: Voice reminder intervention improved hand hygiene compliance among health-care workers in the intervention hospital compared with the control hospital. Voice reminders should be provided in the hospitals by stakeholders. This can help in improving compliance with hand hygiene among health-care workers and reducing the burden of hospital-acquired infections due to the hands of health-care workers.

Transient-evoked otoacoustic emission findings in children (1-12 years) with cerebral palsy in Kano, Nigeria.

BACKGROUND: Children with cerebral palsy (CP) suffer from multiple problems and potential disabilities. These range from musculoskeletal problems, mental retardation, epilepsy, ophthalmologic and hearing impairment among others. Consequences of hearing loss include problems with speech and language development. Early detection in this difficult-to-test population may prevent these consequences of hearing loss. An otoacoustic emission assessment is useful in this regard. This study assessed transient-evoked otoacoustic emissions (TEOAEs) in children with CP. MATERIALS AND METHODS: The study population were children with CP who presented at the paediatric neurology clinic during the study period. An equal number of control population matched for age and sex were also recruited using simple random sampling. An interviewer-administered questionnaire was used to obtain relevant clinical information. All participants selected underwent a detailed ear, nose and throat examination and TEOAE testing. RESULTS: There were 330 participants in this study, categorised into CP cases (165) and non-CP controls (165). The age range of the participants was 1-12 years, with a mean age of 4.44 ± 2.92 among CP patients and 4.47 ± 2.90 among the controls. The male-to-female ratio was 2:1. TEOAEs were 'failed' in 83.6% of the CP patients and in 28.5% of the controls. This study found a statistically significant difference in 'failed' TEOAE result between the CP patients and the controls (P = 0.0001). CONCLUSION: This study found a high prevalence of 'failed' TEOAEs in children with CP in Kano.

Treatment seeking behaviour and associated factors among adults with high blood pressure from three selected states in Nigeria.

Management of hypertension is challenging in multi-cultural and multi-ethnic sub-Saharan African countries like Nigeria. This diversity calls for multi-dimensional interventional approaches for hypertension control. This study assessed the treatment seeking behaviour and associated factors among adults with high blood pressure from three ethnic groups in Nigeria. A cross-sectional study was conducted among 762 adults with high blood pressure from three purposively selected States representing the three main tribes in Nigeria. Using a multistage stratified sampling technique, five communities were selected from two Local Government Areas (LGAs) stratified into urban and rural LGAs in each State. All consenting respondents in each community were consecutively screened for hypertension and recruited. A pretested interviewer-administered questionnaire was used to obtain information on socio-demographic characteristics, treatment seeking behaviour and factors affecting their choice. Data were summarized using descriptive statistics. Relationship between individual, health-related factors and treatment seeking behaviour, as well as the predictors were assessed using a binary logistic regression. at p<0.05 Participants' mean age was 55.4 ± 16.6 years, 63.0% were females and most were Igbo speaking (39.9%). About half (368, 48.3%) were unaware of their status. Of those aware, most (58.9%) went to hospital upon diagnosis of hypertension while some sought advice from health care professionals (28.5%) mostly Hausas, others either went to chemists (6.2%) or did nothing (5.1%), predominantly Yorubas. Significant predictors of orthodox treatment seeking practices for hypertension were female gender [(AOR = 2.60; 95%CI (1.18-5.71)], availability of medicine and personnel [(AOR = 8.7; 95%CI (4.15-18.3)] and perceived good quality of care [(AOR = 4.88; 95%CI (1.81-13.1)]. Orthodox treatment was the common choice among adults with high blood pressure. To further encourage patronage of orthodox treatment, the health facilities should be adequately equipped with medications and trained personnel to improve the quality of care. Targeted education on continuous practice of orthodox treatment is recommended.

Biochemical Mechanism of Insecticide Resistance in Malaria Vector, Anopheles gambiae s.l in Nigeria.

BACKGROUND: Malaria is a parasitic vector-borne disease endemic in the tropical and subtropical countries of the world. The aim of this study was to investigate the current activities of the detoxification enzymes in resistant and susceptible Anopheles gambiae s.l. in northern Nigeria. METHODS: Anopheles larvae were collected from northeast and northwestern Nigeria between Aug and Nov 2018. Biochemical analyses was carried out on the mosquitoes exposed to various insecticides (deltamethrin, DDT, bendiocarb, malathion) to measure and compare the enzymatic activities of the major detoxification enzymes (P450, GSTs, Esterase). RESULTS: High levels of resistance was observed; DDT 37%-53% (95%, CI: 29-61), bendiocarb 44%-55% (CI: 39-60) and deltamethrin 74%-82% (CI: 70-86). However, these mosquitoes were found to be susceptible to malathion 99%-100% (CI: 98-100). The P450 and GSTs enzymes were found to be elevated in the resistant mosquitoes exposed to deltamethrin (1.0240±0.1902); (1.3088±1.2478), DDT (1.7703±1.4528); (1.7462±0.9418) and bendiocarb (1.1814±0.0918); (1.4479±1.0083) compared to the Kisumu strain (0.764±0.4226); (0.6508±0.6542), (0.3875±0.3482); (0.4072±0.4916) and (0.6672±0.3949); (0.7126±0.7259) at P<0.05. Similarly, the resistant mosquitoes expressed increased activity to esterase (0.7606±1.1477), (0.3269±1.1957) and (2.8203±0.6488) compared to their susceptible counterpart (0.6841±0.7597), (0.7032±0.5380) and (0.6398±0.4159) at P<0.05. The enzyme ratio was found to be: P450 (1.341, 4.568 and 1.77); GSTs (2.011, 4.288 and 2.031); Esterases (1.111, 0.469 and 4.408). One way Anova and single sample t-test were also conducted to determine the effect of the enzymes on the resistant and susceptible strains. CONCLUSION: High level of insecticide resistance was observed with significant elevation of detoxification enzymes activities in the resistant mosquitoes.

Current Status of Insecticide Susceptibility in the Principal Malaria Vector, Anopheles gambiae in Three Northern States of Nigeria.

BACKGROUND: Malaria is a major public health problem in Nigeria with 97% of its population with high morbidity and mortality. Mosquitoes play an important role in the transmission of malaria parasites. This study was conducted to evaluate the current resistance status of Anopheles gambiae to insecticides. METHODS: Larvae of An. gambiae was collected from three zones; A, B and C differentiated on the basis of variation in agricultural ecosystems between August and November, 2018 in the northeast and northwestern parts of Nigeria. They were carefully reared to adult stage and insecticidal susceptibility tests were conducted. RESULTS: The mosquitoes tested showed high levels of resistance to all the insecticides used with the exception of malathion. Study zone A, recorded 74% mortality after 24h to deltamethrin compared to 81% from zone B and 82% from zone C, respectively. Mosquitoes from zone B exposed to DDT had the highest level of resistance at 37% compared to 40% and 53% from zones A and C, respectively. Resistant to bendiocarb was also observed, with zone A having the lowest mortality of 44% compared to 48% from zone C and 55% from Zone B, respectively. According to the results of knockdown tests, mosquitoes from Zone A exposed to deltamethrin recorded the lowest knockdown across the study locations while zone B recorded the lowest knockdown for DDT. CONCLUSION: The results of the study provide an insight into the current status of An. gambiae to four major insecticides in northern Nigeria as guideline for mosquitocontrol.

Prevention of Mother-to-child HIV Transmission in Nigeria: Six Years' Experience from a Tertiary Institution.

BACKGROUND: In line with global standards and progress made in Prevention of Motherto- Child Transmission (PMTCT), an assessment of the outcome of Early Infant Diagnosis in northern Nigeria is necessary to evaluate progress towards zero Human immunodeficiency Virus (HIV) infection among children. OBJECTIVES: This study assessed the infection rate and risk factors for mother-to-child HIV transmission among HIV-exposed children in Kano, northwest Nigeria. METHODS: Using a retrospective cohort design, pregnant HIV-positive women and their exposed infants were recruited over a period of six years (2010 to 2016). Participants were enrolled during pregnancy or at delivery in the PMTCT clinic of a tertiary health facility in Kano, Nigeria. The main outcomes for the study were Early infant diagnosis positivity for HIV at 6 weeks and risk factors for positivity. RESULTS: Of the 1,514 infants studied, early infant diagnosis was positive for HIV among 13 infants (0.86%). Infants whose mothers did not have antiretroviral therapy (adjusted Prevalence Ratio aPR = 2.58, 95%CI (1.85- 3.57)), who had mixed feeding (aPR = 12.06, 95%CI (9.86- 14.70)), and those not on antiretroviral prophylaxis (aPR = 20.39, 95%CI (16.04- 25.71)) were more likely to be infected with HIV. HIV-exposed infants on nevirapine and zidovudine prophylaxis were 95% and 74%, respectively, less likely to be infected with HIV. CONCLUSION: HIV infection rate remains high among HIV-exposed infants whose mothers did not receive PMTCT services. Scaling up proven interventions of early commencement of antiretroviral treatment for mothers, adherence to antiretroviral prophylaxis, and avoidance of mixed feeding among HIV-exposed infants would protect future generations from HIV infection.

Implementing COVID-19 response within the context of the broader health system: a proposed framework for Africa´s policy makers.

Heads of government in Africa responded to the COVID-19 pandemic by setting up high-level task forces at continental and national levels to coordinate preparedness and response strategies, in a bid to mitigate the spread of this virus on the continent. However, the current strategy at both continental and national levels are narrowly focused on COVID-19 and this is not sustainable. This is because Africa has a high burden of communicable and non-communicable diseases and sustaining access to essential life-saving health services is also critical during this pandemic. Therefore, we call for a more holistic health systems-based model for COVID-19 outbreak response. We recommend that response strategies should be transitioned from vertical isolated programmes to a broad-based "time-bound" integrated health system intervention that links with existing health programmes as well as other government and non-governmental sectors.

First Report of Target Site Insensitivity in Pyrethroid Resistant Anopheles gambiae from Southern Guinea Savanna, Northern-Nigeria.

BACKGROUND: Malaria is a major public health problem and life threatening parasitic vector-borne disease. For the first time, we established and report the molecular mechanism responsible for Anopheles gambiae s.l. resistance to pyrethroids and DDT from Yamaltu Deba, Southern Guinea Savanna, Northern-Nigeria. METHODS: The susceptibility profile of An. gambiae s.l. to four insecticides (DDT 4%, bendiocarb 0.1%, malathion 5% and deltamethrin 0.05%) using 2-3 days old females from larvae collected from study area between August and November, 2018 was first established. Genomic DNA was then extracted from 318 mosquitoes using Livak DNA extraction protocol for specie identification and kdr genotyping. The mosquitoes were identified to species level and then 96 genotyped for L1014F and L1014S kdr target site mutations. RESULTS: The mosquitoes were all resistant to DDT, bendiocarb and deltamethrin but fully susceptible to malathion. An. coluzzii was found to be the dominant sibling species (97.8%) followed by An. arabiensis (1.9%) and An. gambiae s.s (0.3%). The frequency of the L1014F kdr mutation was relatively higher (83.3%) than the L1014S (39%) in the three species studied. The L1014F showed a genotypic frequency of 75% resistance (RR), 17% heterozygous (RS) and 8% susceptible (SS) with an allelic frequency of 87% RR and 13% SS while the L1014S showed a genotypic frequency of RR (16%), RS (38%) and SS (46%) with an allelic frequency of 40% RR and 60% SS, respectively. CONCLUSION: This study reveals that both kdr mutations present simultaneously in Northern-Nigeria, however contribution of L1014F which is common in West Africa was more than twice of L1014S mutation found in East Africa.