COVID-19 surveillance in Democratic Republic of Congo, Nigeria, Senegal and Uganda: strengths, weaknesses and key Lessons.

INTRODUCTION: As part of efforts to rapidly identify and care for individuals with COVID-19, trace and quarantine contacts, and monitor disease trends over time, most African countries implemented interventions to strengthen their existing disease surveillance systems. This research describes the strengths, weaknesses and lessons learnt from the COVID-19 surveillance strategies implemented in four African countries to inform the enhancement of surveillance systems for future epidemics on the continent. METHODS: The four countries namely the Democratic Republic of Congo (DRC), Nigeria, Senegal, and Uganda, were selected based on their variability in COVID-19 response and representation of Francophone and Anglophone countries. A mixed-methods observational study was conducted including desk review and key informant interviews, to document best practices, gaps, and innovations in surveillance at the national, sub-national, health facilities, and community levels, and these learnings were synthesized across the countries. RESULTS: Surveillance approaches across countries included - case investigation, contact tracing, community-based, laboratory-based sentinel, serological, telephone hotlines, and genomic sequencing surveillance. As the COVID-19 pandemic progressed, the health systems moved from aggressive testing and contact tracing to detect virus and triage individual contacts into quarantine and confirmed cases, isolation and clinical care. Surveillance, including case definitions, changed from contact tracing of all contacts of confirmed cases to only symptomatic contacts and travelers. All countries reported inadequate staffing, staff capacity gaps and lack of full integration of data sources. All four countries under study improved data management and surveillance capacity by training health workers and increasing resources for laboratories, but the disease burden was under-detected. Decentralizing surveillance to enable swifter implementation of targeted public health measures at the subnational level was a challenge. There were also gaps in genomic and postmortem surveillance including community level sero-prevalence studies, as well as digital technologies to provide more timely and accurate surveillance data. CONCLUSION: All the four countries demonstrated a prompt public health surveillance response and adopted similar approaches to surveillance with some adaptations as the pandemic progresses. There is need for investments to enhance surveillance approaches and systems including decentralizing surveillance to the subnational and community levels, strengthening capabilities for genomic surveillance and use of digital technologies, among others. Investing in health worker capacity, ensuring data quality and availability and improving ability to transmit surveillance data between and across multiple levels of the health care system is also critical. Countries need to take immediate action in strengthening their surveillance systems to better prepare for the next major disease outbreak and pandemic.

Trends of infant vaccination timeliness and completion in selected urban slum communities in Ibadan, Southwestern Nigeria: A four-year review.

BACKGROUND: Suboptimal infant vaccination is common in Nigeria and multiple interventions have been deployed to address the situation. Child health indicators are reported to be worse in urban slums compared with other urban areas, but urban data are usually not disaggregated to show these disparities. Examining the timeliness and completion of infant vaccination in urban slums is important to determine the effectiveness of existing interventions in improving infant vaccination among this vulnerable population. This study explored the trends of infant vaccination in selected urban slum communities in Ibadan, Southwest Nigeria between November 2014 and October 2018. METHODS: This was a cross sectional study where infant vaccination data were extracted from the immunization clinic records of six primary health care centers that were providing infant vaccination services for seven urban slum communities. Data was analyzed using descriptive statistics and Chi square test at α = 05. RESULTS: A total of 5,934 infants vaccination records were reviewed, 2,895 (48.8%) were for female infants and 3,002(50.6%) were from Muslim families. Overall, only 0.6% infants had both timely and complete vaccination during the four years under study. The highest number of infants with timely and complete vaccination were seen in 2015(12.2%) and least in 2018(2.9%). Regarding timeliness of the vaccines, BCG, was the least timely among the vaccines given at birth and the pentavalent and oral polio vaccines' timeliness reduced as the age of the infants increased. Both yellow fever and measles vaccines were timelier than the pentavalent vaccines. Vaccines were most timely in 2016(31.3%) and least timely in 2018(12.1%). Those from Muslim families significantly had delayed and incomplete vaccinations compared with those from Chrisitan families (p = 0.026). CONCLUSION: Infant vaccinations were significantly delayed and incomplete in the study communities during the years reviewed. More focused interventions are required to ensure optimal vaccination of the infants.

Improving timeliness and completion of infant vaccination among infants in Nigerian urban slums through older women's participation.

Nigerian urban slums have a high population of infants with suboptimal vaccination despite previous interventions. Older women traditionally play supervisory roles in infant care in Nigeria but their influence is untapped in infant vaccination. This study sought to determine if training of older women (≥35 years) in urban slum communities in Ibadan, South west Nigeria, and involving them in infant vaccination will improve infant vaccination timeliness and completion. This was a randomized experimental community study and pregnant women in their third trimester, residing in seven urban slum communities were randomized using their antenatal clinics (ANCs) into intervention (six ANCs) and control groups (six ANCs). The older women who will supervise the care of the infants of pregnant women in the intervention group had seven sessions of training on the importance of infant vaccination timeliness and completion. The vaccinations of the infants from both groups were compared from birth till 9 months. Data were analyzed using descriptive statistics and Chi square test at α = 0.05. There were 96 older women, 198 pregnant women (105 in intervention group and 93 controls) and 202 infants (109 in intervention group and 93 controls). Infants in the intervention group (67.9%) significantly had both timely and complete vaccinations compared with those in the control group (36.6%). Vaccines given at birth were the least timely in both groups. More infants whose older women caregiver were married had timely and complete vaccinations. Also, a higher proportion of male infants, low birth weight babies and infants with older women caregiver with at most two children had timely and completed vaccinations but these were not statistically significant. Training of older women caregivers improved infant vaccination timeliness and completion in these urban slum communities. This model may improve infant vaccination in other similar urban slum settings.

Contextual interpretation of COVID-19 pandemic among public space users in Ibadan Metropolis, Oyo State, Nigeria: An ethnographic review.

The COVID-19 pandemic has affected all dimensions of lives and has become a social problem as it continues to spread widely through the continuous interactions of people in public spaces where they earn a living. Curbing the spread of COVID-19 requires restrictions in these public spaces, however, the compliance to these measures depends largely on the understanding and interpretations of COVID 19 by users of these public spaces. This study examined the contextual interpretations of public space users about COVID-19 prevention in Ibadan Metropolis, Oyo State. The study was a rapid ethnographic survey in selected public spaces (markets and commercial motor parks) in Ibadan metropolis. Data were collected through participant observation, key informant interviews (3 females; 3 males) and in-depth interviews (30) with, traders, head porters, clients/buyers and commercial vehicle drivers in these public spaces. Interviews conducted were transcribed, sorted into themes using Atlas-ti 7.5.7 and subjected to interpretive-content analysis. Findings revealed that some respondents felt COVID-19 was brought into Nigeria by rich frequent global voyagers, others felt it was through "uncultured" sexual life or wrath of God. Some also doubted the existence of the disease and many of the respondents perceived COVID-19 as a disease reported by the government or a political propaganda to siphon funds. The users of the public spaces in Ibadan Metropolis have variegated perception about the existence and severity of this rapidly spreading virus and this has grave implications for COVID-19 control in the State. Thus, regular interaction with public space users are essential for control efforts.

Effect of intensive training in improving older women's knowledge and support for infant vaccination in Nigerian urban slums: a before-and-after intervention study.

BACKGROUND: One of the strategies for improving vaccination uptake is to make communities understand the importance of immunization and this is expected to drive the demand for vaccines. Building the capacity of older women who supervise child care in Africa may improve infant vaccination in underserved communities. This study determined the impact of training of older women on their knowledge and support for infant vaccination in selected urban slum communities in Ibadan, Nigeria. METHODS: This was a before-and-after study that enrolled women aged ≥35 years. They were trained with a manual and short video using participatory learning methods over an 8 month period. The content of their training includes importance of immunization timeliness and completion, how vaccines work and how to be advocates and supporters of infant vaccination. Their knowledge and support for infant vaccination at baseline were compared with post training values using Student's t test and Chi square test with the level of significance set at 5%. RESULTS: There were 109 women with mean age 55.8 ± 11.6. they had a mean of 5.7 ± 2.1 training sessions. At the end of the training, their knowledge about infant vaccination and the support they give to it increased from 4.8 ± 3.8 to 10.7 ± 0.6, and 3.1 ± 3.5 to 8.1 ± 1.7 respectively. Those with good knowledge about infant vaccination increased significantly from 37(33.9%) to 82(82.8%), while those with good support for the same increased from 31(28.4%) to 85(85.9%). Women who were ≤ 64 years significantly had improved knowledge after the training compared to the older ones. Those with post secondary education had better knowledge and greater support for infant vaccination at baseline. However, there was no difference in the knowledge and support for infant vaccination among the women across the different educational levels after the training. CONCLUSIONS: Participatory learning improved the knowledge about, and support for infant vaccination among older women supervising child care in these urban slum communities. Similar training may be extended to comparable settings in order to improve demand for infant vaccination.

Is evidence-based medicine a mirage in resource-constrained settings? A survey among resident doctors in selected teaching hospitals in Nigeria.

AIM: The study aimed to assess the self-rated knowledge, attitude toward, and practice (KAP) of evidence-based medicine (EBM) among resident doctors in Nigeria. METHODS: This was a cross-sectional web-based survey among 238 resident doctors in four selected teaching hospitals in southern Nigeria. Survey questionnaire contained items assessing the KAP of EBM, familiarity with and understanding of key EBM terms, the use of EBM in decision making, barriers militating against EBM and ways to improve EBM adoption. Proportions and summary statistics were reported for the distribution of survey items. RESULTS: Mean number of years in clinical practice was 9.3 ± 4.5 years. Respondents were uniformly distributed in major clinical specialties. The majority (70.5%) were senior registrars. Respondents' understanding of EBM components included; current best clinical evidence (98.3%), clinical expertise (65.5%), and patients' choices (36.6%). Self-rated familiarity with EBM terms was high while perceived understanding of the terms was lower. The least understood concept was heterogeneity (20.6%). The attitude toward EBM was generally positive. Only about half (53.6%) had used medical bibliographic databases within the last 6 months prior to the survey. Barriers against EBM included lack of time (47.1%) and lack of requisite skills (32.4%). Suggestions to improve EBM adoption included training (58.1%), provision of free Wi-Fi, and free access to bibliographic databases (25.2%) and increased political will (23.1%). CONCLUSION: A further understanding of the EBM concept, provision of enabling infrastructure, regular clinical audit and advocacy to hospital management and clinical consultants, may improve the level of adoption of EBM.

Uptake of intermittent preventive treatment for malaria in pregnancy among women in selected communities of Ebonyi State, Nigeria.

BACKGROUND: Malaria in pregnancy has adverse effects on maternal and child health. Intermittent preventive treatment (IPTp) with three doses of Sulfadoxine/Pyrimethamine is an effective preventive measure for malaria in pregnancy. However, 24.0% of women use this prophylactic regimen in Ebonyi State. Previous studies have focused on the level of uptake with less attention given to factors influencing uptake. Therefore, we examined the predictors of IPTp uptake in the last pregnancy among women in Ebonyi State, Nigeria. METHODS: This was a community-based cross-sectional study among 340 women of reproductive age selected using multistage sampling technique. A semi-structured interviewer administered questionnaire was used to collect data on socio-demographic characteristics of respondents, IPTp uptake and reasons for not taking IPTp. Adherence was judged adequate if three or more doses of IPTp were taken, otherwise inadequate. Data were analyzed using descriptive statistics, Chi- square test and logistic regression model at 5% level of significance. RESULTS: Mean age of respondents was 28.8 ± 5.2 years, 96.5% were married, 19.4% had tertiary education, and 11.2% were from polygamous family. Uptake of IPTp was 74.2%. The level of IPTp uptake was 12.5 and 41.0% among women with no formal and tertiary education respectively. A similar pattern of IPTp uptake was observed among women from monogamous (38.0%) and polygamous (39.5%) families. Women education, husband education and family type were associated with uptake of IPTp, however only husband education remained a predictor of uptake. Women whose husband had secondary education (aOR = 4.1, 95%CI: 1.66-10.06) and tertiary education (aOR = 4.8, 95%CI: 1.76-12.90) were more likely to have IPTp uptake than those whose husbands had below secondary education. CONCLUSION: Adequate IPTp uptake among women in their last pregnancy was below WHO recommendation. Intervention aimed at improving couple's education could facilitate increase in IPTp uptake in Ebonyi State.

Integrated disease surveillance and response strategy for epidemic prone diseases at the primary health care (PHC) level in Oyo State, Nigeria: what do health care workers know and feel?

INTRODUCTION: Effective diseases surveillance remains an important operational tool in countries with recurrent epidemic prone diseases (EPDs). In Nigeria, insufficient knowledge among Health Care Workers (HCWs) on Integrated Disease Strategy and Response Strategy (IDSR) have been documented. This study assessed knowledge and attitude of HCWs towards IDSR strategy for EPDs at the Primary Health Care (PHC) level in Oyo State, Nigeria. METHODS: A cross-sectional facility based study using an interviewer-administered questionnaire was used to obtain information from 531 HCWs. In addition, 7 Key Informant Interviews was conducted. Discrete data were summarized as proportions while chi-square test was used to assess association between variables. A logistic regression model was used to assess predictors of knowledge of HCWs. All statistical significance was set at 5%. RESULTS: Mean age of respondents was 42 ± 8.1 years with female preponderance (86.1%). Community Health Extension Workers (CHEWs) (36.9%) constituted the highest proportion of HCWs. About 70% and 90% of HCWs had good knowledge of EPDs and IDSR surveillance data flow respectively. Majority of HCWs 333(67.3%) knew how to use IDSR form 003 but less than 10% knew how to use other IDSR forms. The majority of HCWs {492(99.4%) and 345(69.7%)} agreed that reporting EPDs is necessary and IDSR tools are simple to use. Number of years post basic qualification was a predictor of HCWs' knowledge (AOR: 1.6; 95% CI: 1.0-2.3). CONCLUSION: This study showed poor knowledge on the use of IDSR forms although majority of HCWs had good knowledge and positive attitude towards IDSR strategy for EPDs. Thus, regular evaluation of health workers' knowledge and attitude towards IDSR strategy as a performance function of the surveillance system is recommended.