An evaluation of the surveillance system for monitoring and reporting adverse events following immunization in Kebbi State, Northern Nigeria: a mixed method approach.

INTRODUCTION: Despite the benefits of periodic evaluation of the vaccine safety surveillance system, no formal assessment, to our knowledge, has been conducted in Nigeria. Hence, this study evaluated the surveillance system for adverse events following immunization (AEFI) to ascertain the system's functionality to inform vaccine safety considerations and guide communication strategies for demand generation. MATERIALS AND METHODS: The study employed a mixed-method approach. Survey questionnaires were administered to 274 routine immunization service providers in Kebbi State, Northern Nigeria, and data were analyzed descriptively using SPSS. In this study, 10 Key Informant Interviews and two Focus Group Discussions were conducted with senior officers and managers at sub-national and national levels within the immunization and surveillance landscape in Nigeria. The interview recordings were cleaned minimally, transcribed, and manually analyzed thematically. Finally, methodological triangulation was done to improve research rigor and provide a better understanding of the phenomena under investigation. RESULTS: Of the respondents, 201(73.4%) reported that the surveillance system can inform vaccine safety considerations while 170(62%) reported that the AEFI surveillance system can determine the magnitude of AEFI within the population. Further, 173(63%) reported that the surveillance system can provide timely feedback about causality assessment. However, 158(58%) of the respondents stated that the surveillance system is competent in informing communication strategies to improve immunization demand. Triangulation was done which showed dissonance in AEFI surveillance and vaccine safety considerations but partial agreement in immunization demand generation. Further, AEFI surveillance system attributes' triangulation revealed agreements (convergence) on simplicity and timeliness; partial agreements on acceptability, data quality, sensitivity, flexibility, and completeness; dissonance on representativeness and silence on stability, indicating a sub-optimal performance of the AEFI surveillance system in the study setting. Finally, the study unearthed some underlying health system factors impeding the AEFI surveillance system from fully fulfilling its objectives. CONCLUSION: The AEFI surveillance system in Northern Nigeria is well established but functioning sub-optimally. Based on the study findings, the capacity to provide information on vaccine safety exists but it is not robust enough to generate sufficient and convincing vaccine safety data and guide communication strategies for vaccine demand generation, especially for new vaccines and those under emergency authorization use.

Factors influencing vaccination up-take among nomadic population in four regions of Ghana: a qualitative study.

BACKGROUND: Vaccination has contributed to the reduction in vaccine preventable diseases. Despite, improved global coverage, vaccination among nomadic populations is still low especially in Africa. This study explored factors influencing vaccination uptake among pastoralist nomads in Ghana. METHODS: We conducted key informant interviews (KII) in 11 districts across four regions of Ghana, using grounded theory qualitative research approach. One hundred and eighty-two KII were conducted among pastoralist nomads, community opinion leaders, community health volunteers, security services personnel, local government personnel and health workers. Guided by the WHO health systems building blocks, data was coded using Nvivo 12 and analysed thematically. Results were presented as narratives with excerpts to support the findings. RESULTS: Community leaders support vaccination among pastoralist nomads as part of their leadership and governance responsibilities. Language barrier between health workers and pastoralist nomads affects service delivery. Also, healthcare providers fear being attacked by pastoralist nomads hence are hesitant to visit their settlements for vaccination. With regards to health workforce, healthcare providers' perceived use of derogatory words and discrimination against pastoralist nomads influence their vaccination uptake. On medical product, the lack of knowledge about diseases, severity and perceived negative effects about vaccines influence vaccination uptake. Inadequate funds and logistics at the district health directorates affects outreach to nomads during vaccinations. Leveraging existing partnership between the health services and community leaders, information centers, volunteers and butchers to send health information to pastoralist nomads influence vaccination uptake. CONCLUSION: Community leaders support vaccination among pastoralist nomads. Nomadic pastoralist miss vaccination dues to language barrier, feel discriminated against, and lack information about diseases and vaccinations. Strengthening Ghana Health Service collaboration with leaders of pastoralist nomads could build trust, create awareness and overcome language barrier between healthcare providers and pastoralist nomads.

Barriers to optimal AEFI surveillance and documentation in Nigeria: Findings from a qualitative survey.

Effective spontaneous AEFI reporting is the first step to ensuring vaccine safety. Half of the global population lives in countries with weak vaccine safety monitoring systems, especially in the African, Eastern Mediterranean, and Western Pacific regions. Further, Immunisation services have been upscaled without commensurate effective AEFI surveillance systems. Hence, this study aims to comprehensively investigate the impediments to an effective AEFI surveillance system. Given the programmatic and regulatory implications, understanding these impediments would facilitate the development and implementation of policies and strategies to strengthen the AEFI surveillance system in Nigeria. A qualitative research design (using a grounded theory approach) was employed by conducting ten key informant interviews and two Focus Group Discussion sessions among the study population to identify the barriers impeding optimal AEFI surveillance and documentation in Nigeria. This study found that the AEFI surveillance system is in place in Nigeria. However, its functionality is sub-optimal, and the potential capacity is yet to be fully harnessed due to health systems and socio-ecological impediments. The identified impediments are human-resource-related issues- knowledge gaps; limited training; lack of designated officers for AEFI; excessive workload; poor supportive supervision and attitudinal issues; caregiver's factor; governance and leadership- moribund AEFI committee; lack of quality supervisory visit and oversight and weak implementation of AEFI policy guidance. Others include funding and logistics issues- no dedicated budget provision and weak referral mechanism; insecurity; socio-economic and infrastructural deficits- poverty, geographical barriers, limited ICT skills, and infrastructure; and poor feedback and weak community engagement by the health workers. Findings from this study provide empirical evidence and serve as an advocacy tool for vaccine pharmacovigilance strengthening in Nigeria. Addressing the impediments requires health system strengthening and a whole-of-the-society approach to improve vaccine safety surveillance, restore public confidence and promote vaccine demand, strengthen PHC services, and contribute to attaining UHC and SDGs.

Immunisation services in North-Eastern Nigeria: Perspectives of critical stakeholders to improve uptake and service delivery.

We investigated the perspectives of parents, health workers (HWs) and traditional medical practitioners (TMPs) on immunisation advocacy, knowledge, attitudes and immunisation practice and ways of improving immunisation uptake in Borno State, North-eastern Nigeria. A cross-sectional study analysing quantitative data from the three stakeholders' categories. It was conducted across 18 local government areas of Borno State. A representative sample of 4288 stakeholders (n=1763 parents, n=1707 TMPs, and n=818 HWs aged 20 to 59years, had complete data. The sample has more males: 57.8% (Parents); 71.8% (TMPs) and 57.3% (HWs). The awareness of immunisation schedule among the stakeholders ranged from 87.2 to 93.4%. The study showed that 67.9% of the parent and 57.1% of the health workers had participated in immunisation except the TMPs (27.8%). Across the stakeholders' categories, between 61.9 and 72.6% have children who had Adverse Event Following Immunisation (AEFI). The most common AEFI was fever. Safety concerns, preference for herbs and charm, culture and religions, and vaccination perception as a western culture were the major barriers to immunisation uptake. While 63.6 to 95.7% of respondents indicated that community leaders, religious and spiritual leaders and TMPs should be involved in immunisation advocacy, 56.9-70.4% of them reported that community leaders should be involved in immunisation policy. Upscaling the critical stakeholders' involvement in advocacy, policy development and implementation of immunization activities may improve acceptance, create demand and engender ownership in vulnerable communities of Borno State, Nigeria. AEFI could be detrimental to immunisation access and utilization. Consequently, health education by health workers needs strengthening to minimise vaccine hesitancy.

First confirmed case of monkeypox in Adamawa State, Nigeria: a clinico-epidemiological case report.

Monkeypox is a rare zoonotic infection caused by monkeypox virus. It is an emerging disease which has become the most prevalent orthopoxvirus since the global eradication of smallpox in 1980. It is a mild illness which is mostly characterized by a prodromal of fever, malaise and progressive appearance of vesiculo-papular skin lesions. We report a case of a 30-year-old military personnel who was referred from 23 Brigade Medical Centre (BMC) to Federal Medical Centre (FMC) Yola on account of fever and progressive eruption of widespread skin rashes. Following isolation from suspicion of monkeypox, he was confirmed by PCR and managed symptomatically and fully recovered within two weeks of onset. His five close contacts did not develop any symptoms during the period of follow-up. This is the first confirmed case of monkey pox in the state. This case will trigger an awareness, amongst clinicians and surveillance officers in Adamawa State, of the existence of monkeypox and heighten the suspicion to promptly detect, isolate and treat more cases to halt transmission.

Description of global innovative methods in developing the WHO Community Engagement Package.

OBJECTIVES: Development of a Community Engagement Package composed of (1) database of community engagement (CE) experiences from different contexts, (2) CE learning package of lessons and tools presented as online modules, and (3) CE workshop package for identifying CE experiences to enrich the CE database and ensure regular update of learning resources. The package aims to guide practitioners to promote local action and enhance skills for CE. SETTING AND PARTICIPANTS: The packages were co-created with diverse teams from WHO, Social Innovation in Health Initiative, UNICEF, community practitioners, and other partners providing synergistic contributions and bridging existing silos. METHODS: The design process of the package was anchored on CE principles. Literature search was performed using standardised search terms through global and regional databases. Interviews with CE practitioners were also conducted. RESULTS: A total of 356 cases were found to fit the inclusion criteria and proceeded to data extraction and thematic analysis. Themes were organised according to rationale, key points and insights, facilitators of CE and barriers to CE. Principles and standards of CE in various contexts served as a foundation for the CE learning package. The package comprises four modules organised by major themes such as mobilising communities, strengthening health systems, CE in health emergencies and CE as a driver for health equity. CONCLUSION: After pilot implementation, tools and resources were made available for training and continuous collection of novel CE lessons and experiences from diverse socio-geographical contexts.

Understanding and experience of adverse event following immunization (AEFI) and its consequences among healthcare providers in Kebbi State, Nigeria: a qualitative study.

BACKGROUND: Vaccines used in the national immunization program are relatively safe and effective. However, no vaccine is perfectly safe. Therefore, adverse reactions may occur. This study aimed to investigate the understanding and experience of Adverse Event Following Immunization (AEFI) among healthcare workers and Routine Immunization (RI) officers. METHODS: Phenomenological qualitative study was conducted between June and September 2019, using a semi-structured question guide in Kebbi State, Northwest Nigeria. Face-to-face interviews were conducted with 12 RI providers, eight Expanded Program on Immunization (EPI) officers, and eight Disease Surveillance and Notification Officers. Thematic analysis was used to analyze the data. The interviews were transcribed and translated, then manually analyzed thematically. RESULTS: The knowledge level of healthcare providers on AEFI definition and classification varied and was suboptimal. Error during vaccination was the study participants' most frequently mentioned possible cause of AEFI. Persistent crying, fever, fainting, and swelling and tenderness at injection sites were the AEFI experienced by the healthcare providers in their careers. Block rejection, lower immunization uptake, loss of confidence in RI, attack on RI providers, discrimination of RI providers and divorce threats among spouses were the consequences of AEFI. Supportive supervision of the RI sessions, refresher training on safe injection for RI providers, and symptomatic treatment of clients with AEFI would prevent AEFI consequences. Also, educating caregivers, community sensitization, and dialogue would minimize the consequences of AEFI. CONCLUSIONS: Evidence of a sub-optimal understanding of AEFI was established in this study. Hence, policymakers should consider regular refresher training on AEFI to ensure all RI providers have an optimal understanding of AEFI. Health education of caregivers and parents during RI sessions and community engagement should be considered to minimise AEFI consequences on the immunization program and the society.

Adopting an heterologous prime-boost strategy in COVID-19 vaccination: the need for locally generated evidence in Africa.

The reduction in the severity and prevalence of COVID-19 has been largely due to the rapid development and deployment of COVID-19 vaccines. Consequently, WHO, in partnership with the Coalition for Epidemic Preparedness Innovation, GAVI, the Vaccine Alliance, set up the COVID-19 Vaccines Global Access (COVAX) Initiative. The goal of this initiative is to prevent discrimination between high and low-income/middle-income countries and ensure equitable vaccine distribution. The first COVID-19 vaccine sent to most countries in the region through the COVAX initiative was the Oxford AstraZeneca (ChAdOx1 nCoV-19) vaccine. Due to the reduced protection against variants of concern, safety issues, and supply challenges of the AstraZeneca vaccine in some countries, heterologous booster dose with alternative vaccines for individuals who have received a prime dose of AstraZeneca. Moreover, vaccine mixing (heterologous vaccination) due to its superior immunogenicity and enhanced protection is being recommended even for individuals who are yet to be vaccinated. However, it is important that prior adoption, empirical data on immunogenicity, safety, and reactogenicity be locally generated in populations where such heterologous vaccine is to be implemented. Regrettably, such data from our search in all clinical trial databases is not ongoing in Africa as at the time of writing this manuscript. Therefore, this treatise advocates an experimental arm to generate such robust evidence. This will provide empirical evidence to guide this innovative approach aimed at ensuring equity and access to COVID-19 vaccines in LMICs, particularly countries within the African region.

A health promotion approach to emergency management: effective community engagement strategies from five cases.

Community engagement is crucial for controlling disease outbreak and mitigating natural and industrial disasters. The COVID-19 pandemic has reconfirmed the need to elevate community engagement to build equity, trust and sustained action in future health promotion preparedness strategies. Using the health promotion strategy of strengthening community action enhances the opportunity for better outcomes. There is, therefore, a need to improve our understanding of community engagement practices during crises, scale-up good community engagement initiatives, and improve and sustain people-centered approaches to emergency responses. This paper presents five case studies from the United States, Singapore, Sierra Leone, Kenya and South Africa that demonstrate the potential strengths that can be nurtured to build resilience in local communities to help mitigate the impact of disasters and emergencies. The case studies highlight the importance of co-developing relevant education and communication strategies, amplifying the role of community leaders, empowering community members to achieve shared goals, assessing and adapting to changing contexts, pre-planning and readiness for future emergencies and acknowledgement of historic context.

Tracking the uptake and trajectory of COVID-19 vaccination coverage in 15 West African countries: an interim analysis.

The African Union Bureau of Heads of State and Government endorsed the COVID-19 Vaccine Development and Access Strategy to vaccinate at least 60% of each country's population with a safe and efficacious vaccine by 2022, to achieve the population-level immunity needed to bring the pandemic under control. Using publicly available, country-level population estimates and COVID-19 vaccination data, we provide unique insights into the uptake trends of COVID-19 vaccinations in the 15 countries that comprise the Economic Community of West Africa States (ECOWAS). Based on the vaccination rates in the ECOWAS region after three months of commencing COVID-19 vaccinations, we provide a projection of the trajectory and speed of vaccination needed to achieve a COVID-19 vaccination coverage rate of at least 60% of the total ECOWAS population. After three months of the deployment of COVID-19 vaccines across the ECOWAS countries, only 0.27% of the region's total population had been fully vaccinated. If ECOWAS countries follow this trajectory, the sub-region will have less than 1.6% of the total population fully vaccinated after 18 months of vaccine deployment. Our projection shows that to achieve a COVID-19 vaccination coverage of at least 60% of the total population in the ECOWAS sub-region after 9, 12 and 18 months of vaccine deployment; the speed of vaccination must be increased to 10, 7 and 4 times the current trajectory, respectively. West African governments must deploy contextually relevant and culturally acceptable strategies for COVID-19 vaccine procurements, distributions and implementations in order to achieve reasonable coverage and save lives, sooner rather than later.

Health and Demographic Surveillance System: A Potential Tool for Solving Challenges Associated with Epidemic Surveillance and Social Protection Scheme for COVID-19 Pandemic Response in Nigeria.

Nigeria recorded her first case of COVID 19 in Lagos State on 27th February 2019, and the number of confirmed cases of COVID 19 has risen to 59 287, with 1113 deaths as of 4th October 2020. The commentary highlighted the importance of a health and demographic surveillance system (HDSS) and its potential in addressing surveillance gap, and the inadequacy of existing sociodemographic database used for palliative administration. The authors examined the HDSS in the context of the COVID-19 pandemic response and learning from the Nahuche model. The Nahuche HDSS model has the potential of identifying poor households as it collects standard data on the socio-economic status of each of the households within the demographic surveillance area (DSA). Standard questionnaire in assessing the household socio-economic status adapted from standard surveys, such as Nigeria Health and Demographic Survey and Malaria Indicator Survey, was administered on the household heads of each household every 2 years to monitor socio-economic advancement of the households. Data on variables such as household possessions, including animals and livestock, were collected and analyzed using factor analysis to group the households into different wealth indices. HDSS provides an opportunity to ameliorate the challenges associated with halting the spread of the virus in the areas of surveillance and administration of palliatives in Nigeria, where there is a paucity of reliable demographic and household-level socio-economic data. This paper calls for the setting up of a functioning HDSS in each region of Nigeria to address the dearth of reliable data for planning health and socio-economic interventions.

Medical waste management at the primary healthcare centres in a north western Nigerian State: Findings from a low-resource setting.

Objectives: This study aims to examine medical waste management (MWM) practices and identify the challenges of optimal MWM at the primary healthcare (PHC) level in Kebbi State, Nigeria. Study design: This study was a cross-sectional survey of 265 primary healthcare workers (PHCWs) and health facilities (HFs) in Kebbi State. Methods: The study tool used was a questionnaire adapted from the WHO rapid assessment tool on MWM and water sanitation. Descriptive and inferential statistical analyses were conducted using SPSS version 20 software. Results: Data generated from 257 HWs were used in this study. Amidst other findings, only 65 (25%) HFs had MWM guideline or policy document; out of these 65HFs, only 19 (7%) of them had problem with its implementation. Only 42 (16%) HFs had a compensation package or a health insurance policy to take care of their health workers in case of MWM-associated hazards while 22 (9%) HFs had specific budgetary allocation for MWM. Only 105 (41%) HFs had trained staffers on MWM. Sharps, blood/body fluids and domestic wastes were the top three (3) wastes generated among the surveyed HFs. Medical waste treatment was on-site in 124 (48%) HFs and burn-and-bury method was the adopted method of medical waste disposal in 198 (77%) HFs. However, the majority (76%) of the surveyed HWs expressed dissatisfaction about the waste treatment practices adopted in their HFs. Conclusion: Our study revealed a poor level of MWM practices in Kebbi State, Nigeria. The state government and partners need to urgently address the identified operational and policy gaps in MWM in Kebbi State, Nigeria. Furthermore, our study revealed the negative implication of fragmented governance and leadership structure at the PHC level on policy, practice and administration of medical waste management in the Kebbi State, Northwestern Nigeria. Addressing the gaps found in this study would contribute to the attainment of the United Nations Sustainable Development Goals in health and well-being, sustainable cities and communities and contribute to poverty eradication.

Knowledge, attitude and practice towards tuberculosis in Gambia: a nation-wide cross-sectional survey.

BACKGROUND: Early diagnosis and treatment of tuberculosis (TB) are the mainstay of global and national TB control efforts. However, the gap between expected and reported cases persists for various reasons attributable to the TB services and care-seeking sides of the TB care cascade. Understanding individual and collective perspectives of knowledge, attitudes, beliefs and other social circumstances around TB can inform an evidence-based approach in engaging communities and enhance their participation in TB case detection and treatment. METHODS: The study was conducted during the Gambian survey of TB prevalence. This was a nationwide cross-sectional multistage cluster survey with 43,100 participants aged ≥15 years in 80 clusters. The study sample, a random selection of 10% of the survey population within each cluster responded to a semi-structured questionnaire administered by trained fieldworkers to assess the knowledge, attitudes and practice of the participants towards TB. Overall knowledge, attitude and practice scores were dichotomised using the computed mean scores and analysed using descriptive, univariable and multivariable logistic regression. RESULTS: All targeted participants (4309) were interviewed. Majority were females 2553 (59.2%), married 2614 (60.7%), had some form of education 2457 (57%), and were unemployed 2368 (55%). Although 3617 (83.9%) of the participants had heard about TB, only 2883 (66.9%) were considered to have good knowledge of TB. Overall 3320 (77%) had unfavourable attitudes towards TB, including 1896 (44%) who indicated a preference for staying away from persons with TB rather than helping them. However, 3607(83.7%) appeared to have the appropriate health-seeking behaviours with regard to TB as 4157 (96.5%) of them were willing to go to the health facility if they had symptoms suggestive of TB. CONCLUSIONS: About 3 in 10 Gambians had poor knowledge on TB, and significant stigma towards TB and persons with TB persists. Interventions to improve TB knowledge and address stigma are required as part of efforts to reduce the burden of undiagnosed TB in the country.

Beyond SARS-CoV-2: Lessons That African Governments Can Apply in Preparation for Possible Future Epidemics.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has placed unprecedented pressure on healthcare systems, even in advanced economies. While the number of cases of SARS-CoV-2 in Africa compared to other continents has so far been low, there are concerns about under-reporting, inadequate diagnostic tools, and insufficient treatment facilities. Moreover, proactiveness on the part of African governments has been under scrutiny. For instance, issues have emerged regarding the responsiveness of African countries in closing international borders to limit trans-continental transmission of the virus. Overdependence on imported products and outsourced services could have contributed to African governments' hesitation to shut down international air and seaports. In this era of emerging and re-emerging pathogens, we recommend that African nations should consider self-sufficiency in the health sector as an urgent priority, as this will not be the last outbreak to occur. In addition to the Regional Disease Surveillance Systems Enhancement fund (US$600 million) provided by the World Bank for strengthening health systems and disease surveillance, each country should further establish an epidemic emergency fund for epidemic preparedness and response. We also recommend that epidemic surveillance units should create a secure database of previous and ongoing pandemics in terms of aetiology, spread, and treatment, as well as financial management records. Strategic collection and analysis of data should also be a central focus of these units to facilitate studies of disease trends and to estimate the scale of requirements in preparation and response to any future pandemic or epidemic.

Translation of genomic epidemiology of infectious pathogens: Enhancing African genomics hubs for outbreaks.

BACKGROUND: Deadly emerging infectious pathogens pose an unprecedented challenge to health systems and economies, especially across Africa, where health care infrastructure is weak, and poverty rates remain high. Genomic technologies are vital for enhancing the understanding and development of intervention approaches against these pathogens, including Ebola and the novel coronavirus disease 2019 (COVID-19). DISCUSSION: Africa has contributed few genomes of severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) to the global pool in growing open access repositories. To bridge this gap, the Africa Centre for Disease Control and Prevention (ACDC) is coordinating continent-wide initiatives to establish genomic hubs in selected well-resourced African centres of excellence. This will allow for standardisation and efficient and rapid data generation and curation. However, the strategy to ensure capacity for high-throughput genomics at selected hubs should not overshadow the deployment of portable, field-friendly and technically less demanding genomics technologies in all affected countries. This will enhance small-scale local genomic surveillance in outbreaks, leaving validation and large-scale approaches to be taken at central genomic hubs. CONCLUSION: The ACDC needs to scale-up its campaign for government support across African Union countries to ensure the sustainable financing of its strategy for increased pathogen genomic intelligence and other interventions in current and inevitable future epidemics in Africa.

The Potential Contribution of Supplementary Immunization Activities to Routine Immunization in Kebbi State, Nigeria.

Background: Among the strategies of the Polio Eradication Initiative, the landmark interventions are routine immunization (RI) and supplementary immunization activities (SIAs). RI is the provision of vaccination service at the health facility and conducted year-round. SIAs are a community-based intervention targeting large numbers of an eligible population within a short period. Hence, the study aimed to assess the contributions of SIAs on access and utilization of RI services. Methods: We conducted the study in 10 local government areas in Kebbi State, northwestern Nigeria. We analyzed RI data from January to September 2019 and included the 4 SIAs conducted in January, April, August, and September in the same years. The number of children vaccinated, the trend of BCG, pentavalent vaccine at 6 and 10 weeks, and measles coverage and dropout rates (DORs) were analyzed. Results: For all the selected vaccines, the highest contributions to RI were recorded during the August 2019 fractional Inactivated Polio Vaccine (fIPV) campaign. On the other hand, the least contributions were noted during January SIAs. The BCG coverage showed an erratic trend with the lowest in February and highest in July 2019. The coverage for the pentavalent vaccine at 6 and 10 weeks was lowest in February and September. The pentavalent vaccine DOR pattern showed the lowest in February with value of 0% and the highest in June with 12%. Except for May and June, the Pentavalent vaccine DORs for all other months were <10%. February 2019 had the lowest measles coverage. Conclusion: Our study demonstrated that the integration of RI into SIAs could improve RI coverage. and potentially reduce DOR, especially when the integration is of good quality and conducted at short and regular intervals. Although SIAs are instrumental at increasing RI coverage, the disruption of RI services may occur due to overlapping resources and poor planning. Therefore, SIAs should be adequately planned by program managers to strengthen RI service delivery during the SIAs implementation.

Utilization rate and factors influencing the use of HIV counseling and testing services among young females: a community-based study from Nigeria.

OBJECTIVES: This study aims to explore the utilization rate and factors influencing the use of HCT services among young females in Ikorodu, Lagos State, Nigeria. METHODS: This study was a descriptive cross-sectional survey of 404 females, aged 15-24 years, residing in Ikorodu, Nigeria. Study tool was a questionnaire. Collected data was analyzed using the SPSS version 16 software. RESULTS: The mean age (±SD) of the respondents was 19.3 (±2.6) years and 90.1% were single. Only 148 (36.6%) respondents had ever utilized the HCT service, of which only 40.5% of them were adolescents. Amongst those that had ever utilized HCT services (n=148), only 60.1% of them did so within 12 months prior to the study while only 33.8% of them initiated the demand for testing themselves. According to the respondents, the top two barriers to the utilization of HCT services were: fear of discrimination (82.9%); and fear of unavailability of access to treatment (68.0%), while the top two factors that facilitates its use were: the adoption of counseling-before-testing approach in the HCT service centers (85.9%); and peoples' need for HIV status declaration prior to getting a job employment/marriage partner (85.1%). CONCLUSIONS: The study shows that utilization of HCT service remains low among the respondents. There is an urgent need to encourage the utilization of HCT services among young females in Ikorodu, Nigeria.

Maternal mortality ratio in selected rural communities in Kebbi State, Northwest Nigeria.

BACKGROUND: Maternal mortality remains a topical issue in Nigeria. Dearth of data on vital events posed a huge challenge to policy formulation and design of interventions to address the scourge. This study estimated the lifetime risk (LTR) of maternal death and maternal mortality ratio (MMR) in rural areas of Kebbi State, northwest Nigeria, using the sisterhood method. METHODS: Using the sisterhood method, data was collected from 2917 women aged 15-49 years from randomly selected rural communities in 6 randomly selected local government area of Kebbi State. Retrospective cohort of their female siblings who had reached the childbearing age of 15 years was constructed. Using the most recent total fertility rate for Kebbi State, the lifetime risk and associated MMR were estimated. RESULT: A total of 2917 women reported 8233 female siblings of whom 409 had died and of whom 204 (49.8%) were maternal deaths. This corresponds to an LTR of 6% (referring to 11 years before the study) and an estimated MMR of 890 deaths/100,000 live births (95% CI, 504-1281). CONCLUSION: The findings provide baseline information on the MMR in rural areas of the State. It underscores the need to urgently address the bane of high maternity mortality, if Kebbi State and Nigeria in general, will achieve the health for all by year 2030 as stated in the Sustainable Development Goals (SDGs).