Intussusception in children under five years of age in Enugu, Nigeria.

INTRODUCTION: intussusception is the invagination of a segment of the bowel into a distal segment. It occurs predominantly in infants worldwide. Following documentation of increased incidence after introduction of the first rotavirus vaccine (Rotashield, Wyeth-Lederle), it has become a standard recommendation to maintain surveillance for intussusception as newer rotavirus vaccines are introduced into EPI. Nigeria plans to introduce rotavirus vaccine in 2020. Pre-vaccine introduction surveillance will serve as a baseline to understand the epidemiology of intussusception in Nigeria. METHODS: from 2013 to 2017, prospective enrolment of under five children with intussusception was done following the WHO protocol and using the WHO case report form. Only children who met the Pan American Health Organization/World Health Organization (PAHO/WHO) protocol case definition for intussusception were enrolled. These children were monitored until discharge or death. Clinical features and outcome were recorded in the case report form. RESULTS: a total of 63 cases were enrolled, with age range of 3 to 42 months (median: 6 months, IQR: 5-9 months). Majority were within 4-6 months and 96% were < 12 months old. There were 41 males and 22 females (male to female ratio of 1.9:1). Duration of symptoms before presentation ranged from 2 hours to 15 days (median: 72 hours). Fifty-seven patients had abdominal ultrasound and 52 patients (83%) had surgery. Case fatality rate was 9% and duration of hospitalization ranged from 1 to 30 days (median 10 days, IQR 8-15 days). CONCLUSION: intussusception occurred most commonly in infants but well beyond the proposed age for rotavirus vaccination in the population studied. Late presentation and surgical intervention were common. This data provides a good baseline description of the epidemiology of intussusception.

Acceptability and Willingness-to-Pay for a Hypothetical Ebola Virus Vaccine in Nigeria.

BACKGROUND: Ebola virus disease is a highly virulent and transmissible disease. The largest recorded fatality from Ebola virus disease epidemic is ongoing in a few countries in West Africa, and this poses a health risk to the entire population of the world because arresting the transmission has been challenging. Vaccination is considered a key intervention that is capable of arresting further spread of the disease and preventing future outbreak. However, no vaccine has yet been approved for public use, although various recombinant vaccines are undergoing trials and approval for public use is imminent. Therefore, this study aimed to determine the acceptability of and willingness-to-pay for Ebola virus vaccine by the public. METHODS: The study was a community-based cross-sectional qualitative and quantitative interventional study conducted in two communities, each in two states in Nigeria. An interviewer-administered questionnaire was used to collect information on respondents' knowledge of the Ebola virus, the ways to prevent the disease, and their preventive practices, as well as their acceptability of and willingness-to-pay for a hypothetical vaccine against Ebola virus disease. The association between acceptability of the vaccine and other independent variables were evaluated using multivariate regression analysis. RESULTS: Ebola virus disease was considered to be a very serious disease by 38.5% of the 582 respondents (224/582), prior to receiving health education on Ebola virus and its vaccine. Eighty percent (80%) accepted to be vaccinated with Ebola vaccine. However, among those that accepted to be vaccinated, most would only accept after observing the outcome on others who have received the vaccine. More than 87.5% was willing to pay for the vaccine, although 55.2% was of the opinion that the vaccine should be provided free of charge. CONCLUSION: The level of acceptability of Ebola virus vaccine among respondents was impressive (though conditional), as well as their willingness to pay for it if the vaccine is not publicly funded. In order to achieve a high uptake of the vaccine, information and education on the vaccine should be extensively shared with the public prior to the introduction of the vaccine, and the vaccine should be provided free of charge by government.

Parental acceptance of inactivated polio vaccine in Southeast Nigeria: a qualitative cross-sectional interventional study.

BACKGROUND: The introduction of inactivated polio vaccines (IPV) is imminent. In view of the Polio Eradication and Endgame Strategic Plan 2013-2018, parental acceptance of IPV will be important for achieving universal coverage. In view of the imminent introduction of IPV, it is only reasonable to assess the awareness and acceptance of IPV, so that necessary socio-anthropological measures would be put in place. This study is aimed at determining the level of awareness and acceptance of IPV by parents. METHODS: A cross-sectional study involving 408 parents that brought their children for immunization. Structured-questionnaire was to collect data on the parent's demographic characteristics, awareness and acceptance of IPV. The independent factors that may affect parental acceptability of IPV were evaluated using linear regression analysis. RESULTS: About 53% of the parents had no knowledge of vaccine content and 84.1% had not heard of IPV, and 40.2% were willing to accept IPV. However, with post-intervention (IPV) health education, the level of acceptance of IPV increased to 95.6% and the difference was statistically significant (p=0.0001). 35.3% expressed fear for IPV, and 61.8% cited fear for pain (61.8%). In the rating scale of 1 to 5, doctors (4.7), Nurses (4.0) and staff of the Ministry of Health (4.0) were rated high as reliable media to inform them about a new vaccine. The logistic regression revealed only educational level of mothers (p-value=0.048) was the only significant factor associated with acceptability of IPV. CONCLUSION: The parents' knowledge on vaccine was poor, as well as IPV acceptability (pre health education). But the acceptability was improved with provision of extra information. Although most still preferred OPV, and with improvement in pain management, acceptability of IPV can be improved further. Clear policies and strategies should be immediately developed and implementation of pre-introduction awareness/sensitization on IPV should be commenced.