Protocol for the crowdsourced image-based morbidity hotspot surveillance for neglected tropical diseases (CIMS-NTDs).

INTRODUCTION: Efficient NTDs elimination strategies require effective surveillance and targeted interventions. Traditional methods are costly and time-consuming, often failing to cover entire populations in case of movement restrictions. To address these challenges, a morbidity image-based surveillance system is being developed. This innovative approach which leverages the smartphone technology aims at simultaneous surveillance of multiple NTDs, enhancing cost-efficiency, reliability, and community involvement, particularly in areas with movement constraints. Moreover, it holds promise for post-elimination surveillance. METHODOLOGY: The pilot of this method will be conducted across three states in southern Nigeria. It will target people affected by Neglected Tropical Diseases and members of their communities. The new surveillance method will be introduced to target communities in the selected states through community stakeholder's advocacy meetings and awareness campaigns. The pilot which is set to span eighteen months, entails sensitizing NTDs-affected individuals and community members using signposts, posters, and handbills, to capture photos of NTDs manifestations upon notice using smartphones. These images, along with pertinent demographic information, will be transmitted to a dedicated server through WhatsApp or Telegram accounts. The received images will be reviewed and organized at backend and then forwarded to a panel of experts for identification and annotation to specific NTDs. Data generated, along with geocoordinate information, will be used to create NTDs morbidity hotspot maps using ArcGIS. Accompanying metadata will be used to generate geographic and demographic distributions of various NTDs identified. To protect privacy, people will be encouraged to send manifestation photos of the affected body part only without any identifiable features. EVALUATION PROTOCOL: NTDs prevalence data obtained using conventional surveillance methods from both the pilot and selected control states during the pilot period will be compared with data from the CIMS-NTDs method to determine its effectiveness. EXPECTED RESULTS AND CONCLUSION: It is expected that an effective, privacy-conscious, population inclusive new method for NTDs surveillance, with the potential to yield real-time data for the identification of morbidity hotspots and distribution patterns of NTDs will be established. The results will provide insights into the effectiveness of the new surveillance method in comparison to traditional approaches, potentially advancing NTDs elimination strategies.

Factors associated with health seeking delay in the screening of cervical cancer among women in Imo state, south Eastern Nigeria.

BACKGROUND TO THE STUDY: Cervical cancer is a curable disease if diagnosed early. The mortality rate due to cervical cancer is high worldwide, mainly because of the absence of a functioning screening process and the advanced stage of the disease at diagnosis. The aim of this study was to assess the factors associated with health-seeking delay in the screening of cervical cancer among women in Owerri Municipal LGA, Imo State. METHODS: A descriptive cross-sectional research design was employed in this study on factors associated with health-seeking delay in the screening of cervical cancer among women in Owerri Municipal LGA. A semi-structured questionnaire was used for the study, and Statistical Package for the Social Sciences (SPSS) version 20 was used in the analysis of the data gotten from the study. A probability-based multi-stage sampling method was adopted for the study in recruiting 432 women who participated in it. RESULT: Results from the study showed that most of the women, 117 (27.1 %), were between the ages of 22 and 27. The study found that a high percentage of the respondents, 350 (81.0 %), had heard about cervical cancer screening, and when they were asked who they thought should be screened for cervical cancer, 154 (35.6 %) said women between the ages of 15 and 40. Further findings revealed that, 420 (97.2 %) said they had not been screened for cervical cancer. The study also demonstrated that 260 (60.2 %) believe long distance has an impact on your access to health care. The findings of this study revealed that age (P = 0.0247), educational level of women (P = 0.0214), and monthly income of the women (P = 0.0062) were all significantly associated with health-seeking delay in cervical screening. CONCLUSION: The study concluded that there is no limited knowledge about cervical cancer among women in Owerri Municipal. Long distance to screening facilities, educational background, and monthly income are significantly associated with the delay in seeking health services for cervical screening. RECOMMENDATION: The study recommended that there should be massive awareness and participation in the screening program across the state.

Seasonal Variation and Geographical Distribution of COVID-19 across Nigeria (March 2020-July 2021).

Globally, the novel corona virus infection has continued to witness a growing number of cases since December 2019 when the outbreak was discovered and noted in China. Despite this has not been well studied for the case of COVID-19, human contact, public moveableness and environmental variables could have an impact onairborne'spropagation and virus continuance, such as influenza virus. This study aimed to determine the seasonal variation and geographical distribution of COVID-19 across Nigeria. An internet based archival research design was employed for this study on the seasonal variation and geographical distribution of COVID-19 across Nigeria. This involved the use of goggle mobility data and world map on Corona Virus Infection (COVID-19). The search strategy for getting information for this research was done electronically. The keywords in the case search using the goggle mobility software was "COVID-19 Update", "COVID-19 Update in Nigeria", 'COVID-19 Winter Report', "COVID-19 Case Fatality March 2020-July 2021", "COVID-19 Case Fatality in Nigeria". The data gotten from the goggle motor updates were entered into Statistical Package for the Social Sciences (SPSS) which was used in the analysis of the study. Results from the study, reported that official COVID-19 cases number was significantly higher in the Dry season (October 2020-April 2021) with 59.0% (127,213) compared to 41.0% (85,176) in the wet/rainy season (May-September) it revealed that the dry and rainy seasons had a COVID-19 prevalence of 0.063 and 0.041 respectively. Further results from the study showed that the prevalence of COVID-19 was 0.07% in the North-Central, 0.04% in both the North-East and North-West, 0.03% in the South-West, 0.09% in the South-South, and the highest prevalence of 0.16% in the South-East. Considering the case Fatality rate of COVID-19 during the Dry and Wet Seasons. The study revealed that North-Central had a death toll of 196 (10.4%) out of 9457 confirmed COVID-19 cases hence a fatality of 2.07. Fatality rate of 1.49% in South western Nigeria, South-South Nigeria, 1.49%, South-East accounted to a fatality rate of 1.25%. Nigeria based on the finding of this study records increased fatality in Dry season over wet seasons. The study concluded that prevalence of COVID-19 varies in seasons in Nigeria Hence; further Data and Meteorological analysis on weather variations towards the SARS-CoV-2 Virus spread should be evaluated by future researchers. It is imperative to ensure strict and controlled application of social measures, such as social distancing, mandatory wearing of non-medical masks to prevent droplets from entering the respiratory tract, screening of affected patients along with quarantine is essential to defeat and improve infection control.

Stakeholders' hopes and concerns about the COVID-19 vaccines in Southeastern Nigeria: a qualitative study.

BACKGROUND: Equitable access and high uptake of safe and effective vaccines is critical to ending the COVID-19 pandemic. To ensure the success of these vaccines, particularly in many developing and under-developed parts of the world, the concerns of local communities including fears, potency, and levels of acceptance should be addressed. This study assessed community stakeholders' perceptions in parts of Southeastern Nigeria about COVID-19 vaccine, towards engaging them effectively to ensure the success of the vaccination campaigns. METHODS: A qualitative study was conducted involving fourteen stakeholders from the Southeastern geo-political zone of Nigeria selected using purposive sampling. In-depth semi-structured individual interviews lasting about 30 min were used to collect data. Data analysis was informed by a general inductive approach. RESULTS: Stakeholders hoped that the development and roll out of the vaccines will bring COVID -19 to an end, will help to maintain good health and allow people get back to normal life. On the other hand, stakeholders expressed their concerns and worries about the "speed" with which the vaccines are being produced, possibility of future adverse effects from vaccination, misinformation, and level of preparedness in the health system to implement the vaccine campaign. CONCLUSIONS: This study identified that more needs to be done to improve perceptions of those who influence health decisions in communities towards COVID-19 vaccines. This includes firstly, the involvement of the community and religious leaders in vaccine promotion. Secondly, it is imperative to develop and disseminate persuasive messaging on vaccine effectiveness and safety targeted at both health professionals, policymakers, and the community which are culturally sensitive and address identified concerns among health workers. Thirdly, the health systems should be strengthened and system-level interventions that directly target one or more of the WHO's six health system building blocks: service delivery, health workforce, health information systems, access to essential medicines, financing, and leadership/governance.

Drug Shop Intervention to Enhance Knowledge, Attitude, and Practices of Patent Medicine Vendors for the Control of COVID-19 In Southeastern Nigeria.

Drug shops are the first point of care for most community members in low-resource countries. Because of symptomatic similarities with common illnesses such as malaria, probable coronavirus disease 2019 (COVID-19) cases may seek care at drug shops, where the knowledge and skills required to handle it may be lacking, thereby fostering community spread of the disease. This single-arm study provided an intervention to improve COVID-19-related knowledge, attitude, and practices of patent medicine vendors (PMVs) in 97 participating drug shops selected through cluster sampling in Owerri, southeastern Nigeria. The intervention involved a drug shop sensitization using information, education, and communication material, as well as training on the use of a risk assessment checklist to identify probable COVID-19 cases and to take appropriate action. Data were collected to determine the effect of this intervention using a pre-tested questionnaire and practice observation checklist, first at baseline and then 3 months post-intervention. Data analysis involved exploratory analysis and the t-test to determine pre- and post-intervention mean score differences at the 5% α level. There was post-intervention knowledge improvement on the COVID-19 causative pathogen (98.1% post-intervention versus 61.9% pre-intervention) and disease transmissibility from person to person (95.9% post-intervention versus 81.4% pre-intervention) among other knowledge domains. There was significant post-intervention improvement for positive attitude, with a mean gain score of 2.8 ± 1.7 (t = 4.4, P = 0.005), and preventive practices, with a mean gain score of 6.0 ± 4.7 (t = 4.1, P = 0.007). Engaging patent medicine vendors in the pandemic response plans through targeted interventions such as drug shop intervention could prove vital in the fight against COVID-19.

Knowledge, attitude and perception on cervical cancer screening among women attending ante-natal clinic in Owerri west L.G.A, South-Eastern Nigeria: A cross-sectional study.

BACKGROUND: Cancer of the cervix is the second most common cancer in women globally, and it is a major cause of morbidity and mortality among women in developing countries such as Nigeria. The study assessed the knowledge, attitude and perception on cervical cancer screening among women attending ante-natal clinic in Owerri West, south eastern Nigeria. METHOD: This cross-sectional study was conducted using a random sampling technique among 231 respondents attending ante-natal clinic in a cluster of 4 selected public primary healthcare centres. A structured questionnaire was used for data collection, and data obtained was analysed using a descriptive technique, while the chi-square test was used to test for the influence of age and education level on cervical cancer screening. RESULTS: The result showed that there was a high level of awareness (68.8%) of cervical cancer screening. The majority of women (122 (52.8%)) received this information from friends. Although the majority of the participants had heard about the screening, few of them had basic information on the cause of the disease 44 (19%), prevention 32 (13.9%), risk factors 48 (20.8%) and treatment (23.4%) of the disease. Of the 231 women, 59 (25.5%) strongly agreed they were too young to have cervical cancer and hence there was no need for the screening, while a greater proportion (53 (22.9%)) agreed that the screening is only meant for older women (30-45 years). Expensive cost of screening (68 (29.4%)) and invasion of privacy by male doctors (34.6%) were also strong reasons for avoiding screening. The study revealed strong influence of age (χ2 = 104.37; DF = 10; P<0.001) and level of education (χ2=31.63; DF = 6; P<0.001) on awareness of cervical cancer screening. Moreover, educational status had a significant positive influence (χ2= 54.71; P<0.001) on the cause of cervical cancer, with a higher proportion of participants with post-secondary education. CONCLUSION: Awareness of cervical cancer is high, but the perception that it can be treated is quite low, along with fear of the screening outcome. Age and level of education are significant factors of screening for cervical cancer. Educational programmes encouraging participation in cervical cancer screening should consider involving the use of close peers and friends to educate the women on the importance of screening program.

Determinants of delay in seeking malaria treatment for children under-five years in parts of South Eastern Nigeria.

One of the components of the current WHO strategy to fight malaria is early recognition and prompt and appropriate treatment. We investigated determinants of delay in seeking early and appropriate malaria treatment for children (0-5 years) in Ohaji/Egbema, South Eastern Nigeria. Data was collected using structured pre-tested questionnaires elicited in the local language (Igbo) to 738 consenting mothers within the child bearing age (15-49 years). About twenty-two percent (22%) of the respondents sought treatment within 24 h for their children with malaria and were excluded from further investigation. More than half of the remaining respondents (51.5%) delayed in seeking treatment because they had to watch their children for some days, while 21.4% were due to financial difficulties. The age, parity, marital status/type of marriage and educational attainment of the mothers including family social-economic status were found to be statistically related to delay in seeking appropriate treatment (P < 0.05). Wrong first line treatment choices by the respondents also contributed to this delay. These results underscore the need to improve awareness of mothers and caregivers on the need and ways of seeking early, appropriate and effective treatment for their children who have malaria. This is very important if the WHO strategy of early recognition, prompt and appropriate treatment is to be effective so as to sufficiently reduce mortality and morbidity due to malaria among children in endemic rural areas. It will also aid in the proper management and treatment of other childhood febrile illnesses.

Artemisinin-based combination therapy: knowledge and perceptions of patent medicine dealers in Owerri Metropolis, Imo State, Nigeria and implications for compliance with current malaria treatment protocol.

This study was done to access the knowledge and perceptions of Patent Medicine Dealers (PMDs) in Owerri Metropolis of Nigeria about Artemisinin Based Combination Therapy as first line treatment for malaria using structured pre-tested questionnaires administered to 80 randomly selected and consenting respondents. About 67.5 and 32.5 % of males and females respectively participated in the study. Most of them (56.3 %) had secondary school education with about 50 % having 5-10 years experience in the business. The level of knowledge was shown to be high (82.5 %), with 81.3 % having proper understanding of the term "artemisinin-based combination therapies (ACTs)" and 80 % knowing the correct dosage for ACTs. But despite the level of awareness, only 32.5 % knew the correct timing for administration of the drugs. The result of this study showed no significant relationship between the level of knowledge and either educational attainment (χ(2) = 4.889, df = 4, p value = 0.558) or the years of experience (χ(2) = 29.095, df = 4, p value = 0.000) although knowledge improved a bit as experience increased. 93.8 % in the study reported that ACTs are more effective than other anti-malarial drugs. The quantity of ACT available on counters are low and there is no significant relationship (χ(2) = 18.833, df = 6, p value = 0.004) between the availability of ACT and the quantity of ACT available in stock at the time of this study. This study shows that awareness on ACTs has improved among PMDs, even though other anti-malarial drugs are still in use and are marketed by them. It becomes necessary that efforts towards awareness be scaled up with emphasis on recommended time of administration and correct prescriptions to enhance and sustain intermittent presumptive treatment as an effective method of malaria control since this group of people still provide the major access to drugs in Nigeria and other tropical endemic areas.