COVID-19 and COVID-19 vaccination experiences and perceptions and their predictors among community members during the COVID-19 pandemic in Ebonyi state, Nigeria: an analytical cross-sectional study.

BACKGROUND: COVID-19 is still a disease of global public health importance which requires long term application of control measures as millions of new infections or re-infections and thousands of related deaths still occur worldwide and the risk of an upsurge from new strains of the virus continues to be a threat. The decrease in the use of and non-use of preventive public health measures are among the factors fuelling the disease. The (previous) experiences and perceptions of people regarding the COVID-19 pandemic, COVID-19 vaccination, and the vaccination process are factors that will influence subsequent use of preventive/control measures. We explored the COVID-19 and COVID-19 vaccination and the vaccination process experiences and perceptions, and their predictors, among the community members in Ebonyi state, Nigeria. METHODS: We conducted an analytical cross-sectional study between March 12 and May 9, 2022 among all consenting/assenting community members aged 15 years and above in 28 randomly selected geographical clusters. A structured interviewer-administered electronic questionnaire in KoBoCollect installed in android devices was used to collect data which was analysed using descriptive statistics and bivariate and multivariate generalized estimating equations. RESULTS: Of the 10,825 community members surveyed: only 31.6% had strong COVID-19 experience and perception, 72.2% had good COVID-19 vaccination expectation and perception, and only 54.2% had positive COVID-19 vaccination process experience and perception. The most important predictors of the extent/level of COVID-19 and COVID-19 vaccination and the vaccination process experiences and perceptions were level of attitude towards COVID-19 and COVID-19 vaccination and level of knowledge about COVID-19. Other important predictors were marital status, educational level, and main occupation. CONCLUSIONS: This study's evidence, including the identified predictors, will inform subsequent policy actions regarding COVID-19 in the strategies to improve the COVID-19 and COVID-19 vaccination and the vaccination process experiences and perceptions of community members (and their use of preventive/control measures) in Ebonyi state and Nigeria, and other similar contexts. It will also inform future policy actions/strategies regarding similar diseases.

Prevalence and Pattern of Eye Disorders Among Primary Schoolchildren in Abakaliki, Nigeria: A Cross-Sectional Study.

Background A child's learning ability depends on vision, and visual impairment negatively affects neurological, intellectual, and emotional development by limiting children's exposure to a range of experiences and information. This study aims to determine the prevalence and pattern of ocular morbidity among primary schoolchildren in Abakaliki and provide evidence that can be used in planning a school eye health program for the state. Methodology A school-based, cross-sectional study was conducted within the Abakaliki metropolis between January and April 2018 to determine the ocular health status of schoolchildren recruited using stratified random sampling. Data were analyzed using SPSS version 22 (IBM Corp., Armonk, NY, USA) and presented using descriptive statistics. Univariate analysis was performed to determine the association between dependent and independent variables, with the level of significance determined by a p-value <0.05 (95% confidence interval (CI)). Results A total of 553 schoolchildren aged 6-16 years were examined. The prevalence of eye disorders was 23.5%. Common disorders included refractive error (12.7%) and allergic eye disease (7.1%). Other findings included glaucoma suspect (15, 2.7%), infective conjunctivitis (1, 0.2%), amblyopia (3, 0.5%), cataract (1, 0.2%), and squint (1, 0.2%). The prevalence of visual impairment was 3.1%. Univariate analysis showed a significant association between ocular morbidity and attending private schools (95% CI = 6.5-11.1, p = 0.003). Conclusions Eye disorders such as uncorrected refractive error and allergic conjunctivitis were common among schoolchildren. School eye health programs can ensure that eye screening is done periodically, allowing for early detection, referral, and prompt treatment of eye diseases that can potentially cause visual impairment.

COVID-19 and COVID-19 vaccination experiences and perceptions among health workers during the pandemic in Ebonyi state, Nigeria: An analytical cross-sectional study.

BACKGROUND: COVID-19 continues to be a disease of global public health importance and requires long-term management and control. Health workers' (previous) experiences and perceptions regarding the COVID-19 pandemic and COVID-19 vaccination/vaccination process will influence not only their subsequent use of control measures but also public experiences/perceptions. We explored the COVID-19 and COVID-19 vaccination and the vaccination process experiences and perceptions, and their predictors, among the health workers in Ebonyi state, Nigeria. METHODS: We conducted an online-offline analytical cross-sectional survey between March 12 and May 9, 2022 among all categories of health workers (clinical/non-clinical, public/private) working/living in Ebonyi state who consented to participate and were selected by convenience/snowballing techniques. A structured electronic questionnaire was used to collect data: self-administered via WhatsApp and interviewer-administered via KoBoCollect for participants who did not have WhatsApp. Data was analysed using descriptive statistics and bivariate/multivariate generalized linear models. RESULTS: Of the 1276 health workers surveyed: 55.8% had strong COVID-19 experience and perception, 80.7% had good COVID-19 vaccination expectation and perception, and 87.7% had positive COVID-19 vaccination process experience and perception. The most important predictors of the extent and level of COVID-19 and COVID-19 vaccination and the vaccination process experiences and perceptions were level of place of work (primary-secondary/tertiary), level of attitude towards COVID-19 (vaccination), and level of knowledge about COVID-19. Another important predictor was place of work (public/private). CONCLUSIONS: The evidence indicate the factors that should guide subsequent policy actions in the strategies to enhance the COVID-19 and COVID-19 vaccination and the vaccination process experiences and perceptions of health workers (and their use of control measures) in Ebonyi state, Nigeria, and other similar contexts. It also indicate factors to be considered by future policy actions regarding similar diseases.

COVID-19 information sources, knowledge, attitude, control practices and the predictors among health workers during the pandemic in Ebonyi state, Nigeria.

The COVID-19 pandemic has changed into an endemic COVID-19 disease and health workers continue to be at high risk. The situation requires continued use of COVID-19 control measures by health workers and this will likely depend on their sources of information/knowledge/attitude about COVID-19 and previous use of COVID-19 control measures. We explored the COVID-19 information sources, knowledge, attitude, control practices, and the predictors, among health workers in Ebonyi state, Nigeria. We implemented an online-offline analytical cross-sectional survey from March 12 to May 9, 2022 among all categories of health workers (clinical/non-clinical, public/private) working/living in Ebonyi state who gave consent and were selected via convenience/snowballing sampling. Data was collected with a structured self-administered/interviewer-administered questionnaire via WhatsApp/KoBoCollect. Descriptive/inferential analyses were done including multivariate generalized linear models. 1276 health workers were surveyed. The commonest individual source of information about COVID-19 was health workers (used by 83.8%), followed by radio (67.9%), television (59.6%), family members/relatives/friends (57.9%) etc. The main individual source of information for majority of the participants was health workers (for 35.0%) followed by radio (24.5%), television (14.4%) etc. The most trusted individual source of information for majority of the participants was health workers (for 39.4%) followed by radio (26.0%), television (14.3%) etc. Interpersonal sources were the main/most trusted source of information for the majority (48.0%/49.8%) followed by traditional media (39.4%/40.6%) and internet/social media/SMS (12.6%/9.6%). 42.3%, 81.3%, and 43.0% respectively had good knowledge, good attitude, and good control practice about COVID-19. The most important predictors of the main/most trusted sources of information about COVID-19 were place of work (public/private), level of place of work (primary-secondary/tertiary), age, and years of working experience. Good knowledge about COVID-19, good attitude towards COVID-19, strong COVID-19 experience/perception, working at a tertiary facility, tertiary education, and decrease in years of working experience were strong predictors of good control practice about COVID-19. This study's evidence regarding the commonest/main/most trusted information sources and control practice about COVID-19 should be considered by later COVID-19/similar health emergencies' policy actions to optimise emergency health information dissemination and use of control measures by health workers in Ebonyi state/Nigeria/other similar settings.

Antimicrobial use among paediatric inpatients in a Nigerian tertiary hospital: A three-year point prevalence survey.

Aim: Antimicrobials are among the most widely prescribed therapeutic agents among paediatric population. Irrational use of these agents increases the risk of antimicrobial resistance. We described the prevalence and pattern of antimicrobial use among paediatric inpatients from 2017 to 2019. Subject and Method: The study was a repeated point prevalence survey over a 3-year period using the global point prevalence standardized tools among all paediatric inpatients. The prevalence of antimicrobial use, the prescription indicators and patterns of antimicrobial use were estimated. Result: Among 191 paediatric inpatients assessed, the 3-year period prevalence antimicrobial use was 85.9% (164/191) with prevalence of 80.6% in 2017, 94.6% in 2018, and 83.6% in 2019. Antimicrobial agents used ranged from one agent (20.1%) to five different agents (5.5%). Parenteral route (66.6%) was the preferred route of administration. The reason for the use of antimicrobial agents (92.6%) and the stop/review date (99.5%) were mostly well documented. Only 4.5% of the antimicrobial use were targeted. There were no antimicrobial guidelines or policy guiding the use of antimicrobial agents, except the national guideline on the treatment of malaria and tuberculosis. Ceftriaxone, a third generation cephalosporin was the most commonly used agent across the period under review. Community-acquired infection was the commonest indication for antimicrobial use. Conclusion: Our findings of high antimicrobial prevalence has raised the attention for the need to develop hospital-based antimicrobial guideline and antimicrobial stewardship program to protect the vulnerable children, their contacts and the environment from the impact of antimicrobial resistance.

COVID-19 vaccination acceptance (uptake, hesitancy, intention to receive and timeliness of the intention to receive) and the determinants among health workers in Ebonyi state, Nigeria: an analytical cross-sectional study.

OBJECTIVES: Health workers are at particular risk of contracting the COVID-19. However, non-acceptance of COVID-19 vaccination has been a noticeable challenge the world over and in Nigeria where supply constraints have also been an issue. We evaluated COVID-19 vaccination acceptance (the uptake, hesitancy, intention to receive and timeliness of the intention to receive) and the determinants, and the predictive power of acceptance factor compared with availability/access factor, among health workers in Ebonyi state. METHODS: We conducted an online-offline survey, between 12 March 2022 and 9 May 2022, among all consenting health workers (clinical/non-clinical, public/private) working/living in Ebonyi state and who were selected by convenience and snowballing techniques. Data were collected using structured self-administered questionnaire distributed via WhatsApp and interviewer-administered questionnaire in KoBoCollect installed in android devices. Data were analysed using descriptive statistics and generalised linear models. RESULTS: 1276 health workers were surveyed. Uptake was 68.2% vaccinated, 47.4% fully vaccinated and 20.9% partially vaccinated. Hesitancy was 22.6% or 71.2% among the unvaccinated (76.3% of hesitancy due to refusal and 23.7% to delay). Intention to receive was 36.0% of which 55.1% gave the intended time (days) to receive with a median (IQR) of 30 days (7-133). The strongest and most important predictor of COVID-19 vaccination acceptance was COVID-19 vaccination expectations and perceptions. Other important predictors were COVID-19/COVID-19 vaccination process experiences and perceptions. Acceptance factor was a stronger predictor compared with availability/access factor. CONCLUSION: The slow pace of COVID-19 vaccination coverage among the health workers in Ebonyi state/Nigeria may encounter a bottle-neck due to the high refusal rate among the unvaccinated. COVID-19 vaccination policy interventions in Nigeria and other similar settings should, in addition to sustaining availability and access, prioritise improvement of COVID-19 vaccination expectations and perceptions (regarding importance/safety/effectiveness) and COVID-19 risk communication among the health workers. TRIAL REGISTRATION NUMBER: ISRCTN16735844.

Marked variability in institutional deliveries and neonatal outcomes during the COVID-19 lockdown in Nigeria.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic and the interventions to mitigate its spread impacted access to healthcare, including hospital births and newborn care. This study evaluated the impact of COVID-19 lockdown measures on newborn service utilization in Nigeria. METHODS: The records of women who delivered in hospitals and babies admitted to neonatal wards were retrospectively reviewed before (March 2019-February 2020) and during (March 2020-February 2021) the COVID-19 pandemic lockdown in selected facilities in Nigeria. RESULTS: There was a nationwide reduction in institutional deliveries during the COVID-19 lockdown period in Nigeria, with 14 444 before and 11 723 during the lockdown-a decrease of 18.8%. The number of preterm admissions decreased during the lockdown period (30.6% during lockdown vs 32.6% pre-lockdown), but the percentage of outborn preterm admissions remained unchanged. Newborn admissions varied between zones with no consistent pattern. Although neonatal jaundice and prematurity remained the most common reasons for admission, severe perinatal asphyxia increased by nearly 50%. Neonatal mortality was significantly higher during the COVID-19 lockdown compared with pre-lockdown (110.6/1000 [11.1%] vs 91.4/1000 [9.1%], respectively; p=0.01). The odds of a newborn dying were about four times higher if delivered outside the facility during the lockdown (p<0.001). CONCLUSIONS: The COVID-19 lockdown had markedly deleterious effects on healthcare seeking for deliveries and neonatal care that varied between zones with no consistent pattern.

Socio-demographic and lifestyle factors associated with hypertension in Nigeria: results from a country-wide survey.

With the rising prevalence of hypertension, especially in Africa, understanding the dynamics of socio-demographic and lifestyle factors is key in managing hypertension. To address existing gaps in evidence of these factors, this study was carried out. A cross-sectional survey using a modified WHO STEPS questionnaire was conducted among 3782 adult Nigerians selected from an urban and a rural community in one state in each of the six Nigerian regions. Among participants, 56.3% were women, 65.8% were married, 52.5% resided in rural areas, and 33.9% had tertiary education. Mean ages (SD) were 53.1 ± 13.6 years and 39.2 ± 15.0 years among hypertensive persons and their normotensive counterparts respectively. On lifestyle, 30.7% had low physical activity, 4.1% consumed tobacco currently, and 35.4% consumed alcohol currently. In comparison to unmarried status, being married (OR = 1.88, 95% CI: 1.41-2.50) or widowed (OR = 1.57, 95% CI: 1.05-2.36) was significantly associated with hypertension, compared with never married. Compared with no formal education, primary (OR = 1.44, 95% CI: 1.12-1.85), secondary (OR = 1.37, 95% CI: 1.04-1.81), and tertiary education (OR = 2.02, 95% CI: 1.57-2.60) were associated with hypertension. Low physical activity (OR = 1.23, 95% CI: 1.05-1.42), alcohol consumption, (OR = 1.18, 95% CI: 1.02-1.37), and unemployment status (OR = 1.42; 95% CI: 1.07-1.88) were also associated with hypertension. Our study indicates an association of socio-demographic and lifestyle factors with hypertension, hence, there is a need for counselling, health education and policy formulation and implementation targeting these factors to prevent and control hypertension.

Essential medicines and technology for hypertension in primary healthcare facilities in Ebonyi State, Nigeria.

INTRODUCTION: Cardiovascular diseases (CVDs) now constitute major cause of morbidity and mortality in middle and low income countries including Nigeria. One of the major efforts at controlling CVDs in Nigeria includes expanding universal access to care through the primary healthcare (PHC) system. The study was to assess essential medicines and technology for control of hypertension in PHC facilities in Ebonyi Nigeria. METHODS: The study used mixed method cross-sectional survey to assess availability, affordability and accessibility of essential medicines and technology in 45 facilities and among their patients with hypertension (145). RESULTS: Most of the PHC facilities (71.1%) assessed were rural. The heads of facilities were mainly community health extension workers (86.7%). One (2.2%) facility had a pharmacy technician. All facilities had been supervised by the regulatory authority in the last one year. Out of 15 anti-hypertensive drugs assessed, 10 were available in some facilities (2.2%-44.4%) but essential drug availability was low (<80%). Only mercury sphygmomanometers were available in all facilities with 82.2% functioning. Stethoscopes were available in all facilities and 95.6% were functional. Glucometers were present in 20.0% of facilities and were all functional. All the respondents (100.0%) reported they could not afford their anti-hypertensive drugs. Median monthly income was 8,000 Nigerian Naira (range = 2,000-52,000). Median monthly cost of anti-hypertensive drugs was 3,500 Naira (range = 1,500-10,000). For 99 (68.3%) of the respondents, the facilities were accessible. Median cost of transportation for care was 400 Naira (range = 100-2,000). CONCLUSION: Gaps still exist in the provision of hypertension control services in PHC facilities in Ebonyi State, Nigeria. The essential drugs were not always available, and cost of the drugs were still a challenge to the patients. There is urgent need to expand health insurance coverage to rural communities to ameliorate the catastrophic out-of-pocket health expenditures and improve control of CVDs.

Risk factors for COVID-19 infection and disease severity in Nigeria: a case-control study.

Introduction: identifying risk factors for SARS-CoV-2 infection and disease severity is critical to developing measures to protect vulnerable groups. We aimed to identify risk factors for SARS-CoV-2 infection and severe disease. Methods: this was an unmatched case-control study that recruited participants in the country from April to July 2020. Cases tested positive on Reverse-Transcription Polymerase Chain Reaction (RT-PCR), while controls tested negative on RT-PCR. Data were collected by trained research assistants using an interviewer-administered questionnaire. Cases were categorized into severe and non-severe to identify risk factors for severe disease. Results: there were 497 cases and 997 controls recruited. Contact with a symptomatic confirmed case adjusted odds ratio (aOR) 1.91 (95% CI: 1.30-2.80) and attendance of mass gatherings aOR 1.74 (95% CI: 1.10-2.74) were associated with SARS-CoV-2 infection, while the use of private transportation aOR 0.56 (95% CI: 0.37-0.85) and use of a face mask aOR 0.43 (95% CI: 0.19-0.95) were associated with lower odds of infection. We identified 38 (7.7%) severe cases and 459 (92.3%) non-severe cases. Multivariate analysis identified age ≥ 50 years aOR 4.54 (95% CI: 1.86-11.08), male sex aOR 2.95 (95% CI: 1.07-8.11), hypertension aOR 3.52 (95% CI: 1.46-8.50), and diabetes aOR 5.76 (95% CI: 2.01-16.50) as risk factors for severe disease, while Hausa ethnicity aOR 0.15 (95% CI: 0.04-0.62) lowered the odds of severe disease. Conclusion: our findings highlight the importance of exposure history, mass gatherings, private transportation, and the use of face masks. Being over 50 years, male and having comorbidities indicate a worse prognosis.

COVID-19 vaccination acceptance among community members and health workers in Ebonyi state, Nigeria: study protocol for a concurrent-independent mixed method analyses of intention to receive, timeliness of the intention to receive, uptake and hesitancy to COVID-19 vaccination and the determinants.

INTRODUCTION: The COVID-19 pandemic has gravely affected the lives and economies of the global population including Nigeria. The attainment of herd immunity through mass COVID-19 vaccination is the foremost control strategy, however, the deployments of COVID-19 vaccinations are facing challenges of non-acceptance. Despite the efforts of the Nigerian government and COVAX facility in making COVID-19 vaccination more available/accessible, the vaccination rate remains unexpectedly very low in Nigeria/Ebonyi state. Therefore, it is important to investigate the acceptability of COVID-19 vaccination to elucidate the explanations for the very low coverage rate. This study aims to evaluate/explore COVID-19 vaccination acceptance and the determinants among community members and health workers in Ebonyi state, Nigeria. METHODS AND ANALYSES: The study is an analytical cross-sectional survey with a concurrent-independent mixed method design. Quantitative data will be collected from all consenting/assenting community members aged 15 years and above, in 28 randomly selected geographical clusters, through structured interviewer-administered questionnaire household survey using KoBoCollect installed in android devices. Quantitative data will be collected from all consenting health workers, selected via convenience and snowball techniques, through structured self-administered questionnaire survey distributed via WhatsApp and interviewer-administered survey using KoBoCollect installed in android devices. Qualitative data will be collected from purposively selected community members and health workers through focus group discussions. Quantitative analyses will involve descriptive statistics, generalised estimating equations (for community members data) and generalised linear model (for health workers data). Qualitative analyses will employ the thematic approach. ETHICS AND DISSEMINATION: Ethical approval for this study was obtained from the Ebonyi State Health Research and Ethics Committee (EBSHREC/15/01/2022-02/01/2023) and Research and Ethics Committee of Alex Ekwueme Federal University Teaching Hospital Abakaliki (14/12/2021-17/02/2022), and verbal consent will be obtained from participants. Study findings will be reported at local, national and international levels as appropriate. TRIAL REGISTRATION NUMBER: ISRCTN16735844.

Are rural pregnant women disadvantaged in accessing intermittent preventive treatment in pregnancy in Ebonyi State, Nigeria?

INTRODUCTION: Adequate intermittent preventive treatment (IPTp) uptake (≥3 doses) routinely delivered at antenatal clinics is effective in preventing malaria during pregnancy. Whereas, low IPTp uptake (24.0%) had been reported among pregnant women in Ebonyi State, there is paucity of studies comparing the uptake and its predictors in the urban and rural areas of Ebonyi State. We determined IPTp uptake and its predictors in the urban and rural areas of Ebonyi State. METHODS: We conducted a cross-sectional comparative study among 864 reproductive age women selected using multistage sampling. Using a structured interviewer-administered questionnaire, we collected data on respondent's socio-demographic characteristics and IPTp uptake. Uptake was adjudged adequate if ≥3 doses were taken, otherwise inadequate. We estimated the proportion of women with adequate IPTp uptake and determined the factors associated with adequate uptake in rural and urban areas using chi square and multiple logistic regression at 5% level of significance. RESULTS: The mean ages of respondents in the urban and rural areas were 28.5±4.6 and 27.4±5.0 years respectively. Adequate IPTp uptake was 82.5% and 60.8% in the urban and rural respectively (p<0.001). In the urban area, women whose husbands had attained ≥ secondary education (aOR:2.9; 95%CI:1.2-7.4; p = 0.02) and those who paid for sulfadoxine/pyrimethamime (aOR:0.2; 95%CI: 0.1-0.6; p = 0.01) were 2.9 times more likely and 5 times less likely to take adequate IPTp respectively compared to respondents whose husbands had attained ≤ primary education and those who had sulfadoxine/pyrimethamine free. In the rural area, women who had attended ANC <4 times (aOR:0.4; 95%CI: 0.3-0.7; p<0.001) were 2.5 times less likely to take adequate IPTp compared to women that had attended ANC ≥4 times. CONCLUSION: Uptake of IPTp was more in the urban than rural areas of Ebonyi State. Interventions that reinforce the importance of health professionals carrying out actions aimed at pregnant women and their partners (spousal) in order to guide them on preventive actions against malaria and other diseases are recommended in Ebonyi State.

Awareness Of Occupational Hazards, Use of Personal Protective Equipment and Workplace Risk Assessment Among Welders in Mechanic Village, Abakaliki, South-East Nigeria.

Background: Occupational diseases can result in sickness absence, economic loss, disability, or death of workers. Several studies have revealed that occupational health and safety practice is still low in some occupational groups despite their knowledge and the occupational health legislation. This study assessed the level of knowledge, Background: Occupational health service delivery, includes the creation of a safe and healthy work environment. The protection and promotion of workers' health; is at its infantile stages in the informal sector such as the welding industry in Nigeria. We determined the level and determinants of awareness of occupational hazards, determinants of use of personal protective equipment (PPE) and carried out a workplace risk assessment among the welders at the mechanic village in Abakaliki, Ebonyi State. Methodology: We conducted a cross-sectional study among welders who work in the mechanic village, Abakaliki. A structured, pretested interviewer-administered questionnaire was used to extract information on awareness of occupational hazards, frequency of use of PPE, health-related complaints amongst others. Chi-square test and logistic regression analysis were conducted at a 5% level of significance. Result: All the respondents were male with a mean age of 27.6± 10.1 years. We found a good awareness of occupational hazards in 60% of the respondents and though this was associated with being older than 30years (p=0.03), being an expert compared to apprentice (p=0.003), duration of work more than 5years (p=0.004), none of these factors, when modelled in logistic regression, were predictors of good awareness. Regular use of PPE was reported in 49.79% of respondents. Cuts, sparks, foreign bodies in the eye were the most common hazards they were aware of. Cuts were the most reported health complaint. Good awareness of hazards was associated with higher odds of sustaining cuts (adjusted odds ratio [AOR]: 3.1, 95% CI:1.46 - 6.69) and a predictor of regular use of PPE (AOR:2.6, 95%CI:1.12 - 5.88). The workplace risk assessment revealed a work environment not conducive to occupational safety and health. Conclusion: A good awareness of occupational hazards was moderately high, a predictor of regular use of PPE and not protective of sustaining cuts in the suboptimal work environment.

Early onset of neurological features differentiates two outbreaks of Lassa fever in Ebonyi state, Nigeria during 2017-2018.

Lassa fever (LF) is an acute viral haemorrhagic illness with various non-specific clinical manifestations. Neurological symptoms are rare at the early stage of the disease, but may be seen in late stages, in severely ill patients.The aim of this study was to describe the epidemiological evolution, socio-demographic profiles, clinical characteristics, and outcomes of patients seen during two Lassa fever outbreaks in Ebonyi State, between December 2017 and December 2018. Routinely collected clinical data from all patients admitted to the Virology Centre of the hospital during the period were analysed retrospectively. Out of a total of 83 cases, 70(84.3%) were RT-PCR confirmed while 13 (15.7%) were probable cases. Sixty-nine (83.1%) patients were seen in outbreak 1 of whom 53.6% were urban residents, while 19%, 15%, and 10% were farmers, students and health workers respectively. There were 14 (16.8%) patients, seen in second outbreak with 92.9% rural residents. There were differences in clinical symptoms, signs and laboratory findings between the two outbreaks. The case fatality rates were 29.9% in outbreak 1 and 85.7% for outbreak 2. Neurological features and abnormal laboratory test results were associated with higher mortality rate, seen in outbreak 2. This study revealed significant differences between the two outbreaks. Of particular concern was the higher case fatality during the outbreak 2 which may be from a more virulent strain of the Lassa virus. This has important public health implications and further molecular studies are needed to better define its characteristics.

Trend and determinants of tuberculosis treatment outcome in a tertiary hospital in Southeast Nigeria.

INTRODUCTION: Nigeria ranked 7th among the high TB burden nations globally and second most endemic in Africa. There are several highly effective interventions available for tuberculosis control. Operational challenges have been reported to interfere with the success of these interventions. This review was conducted to ascertain the treatment outcome using the Directly Observed Short Course Strategy implemented in the hospital. METHODS: A retrospective review of the Tuberculosis treatment was conducted in former Ebonyi State Teaching Hospital and Federal Teaching Hospital from 2008 to 2014 as part of the departmental critique of patients' clinical care and tuberculosis control activities. Using the facility's TB treatment register, information on the patient's demography, clinical characteristics and treatment outcome was extracted. The data were analyzed using Epi Info version 7.2. Frequencies and proportions were calculated. RESULTS: A total of 1070 cases were reviewed with majority 491 (45.9%) belonging to 25-44 years age group. There were 585 (54.7%) males and 68 (11.6%) paediatrics. Pulmonary tuberculosis (667, 62.3%) was the most common presentation. Among those that did sputum smear AFB, 53.2% were smear negative. In all, 91.2% of the cases were treatment naïve, 59.1% were HIV negative at beginning of their treatment while 8% had unknown HIV status. Of the treatment outcome, 40.5% were classified as treatment completed, 16.0% cured, 17.4% of the cases defaulted while 14.1% of the cases died on treatment. These patients were often referred from primary and secondary level hospitals. CONCLUSIONS: The cure rate was very poor and treatment default rate high. The high default rate could be due to the referral nature of the hospital. The treatment success rate of 56.5% is still far below the national target of 85% treatment success rate for effective tuberculosis control. An operational research is recommended to elicit the root causes of low treatment success rate and high patient default rate.

Association of hypoalbuminemia and reversal of albumin-to-globulin ratio with morbidity outcome among hospitalized Lassa fever infected patients at a dedicated treatment center in Ondo state, south-western Nigeria.

BACKGROUND: As of this present moment, there is paucity of data on report concerning the association between hypoalbuminaemia or reversal of albumin-to-globulin ratio and morbidity outcome in Lassa fever (LF) infection as a crucial determinant prognostic-predictor factor for treatment-survival outcome. AIM: This study was designed to determine the association between hypoalbuminaemia, reversal of albumin-to-globulin ratio and morbidity outcome among confirmed LF infected patients. METHODOLOGY: This was a descriptive retrospective study involving the assessment of records of confirmed LF infected patients that were managed at the center from November 2018 to October 2019. RESULTS: Out of 83 recruited participants with complete records, 66 (79.5%) had hypoalbuminaemia, 74 (89.2%) had reversal of albumin-to-globulin ratio. A higher mean value of total white blood cell (WBC) count was observed among patients with hypoalbuminaemia (p < 0.0001) and reversal of albumin-to-globulin ratio (p < 0.0001) when compared to patients with normal values, respectively. Also, this study showed statistically significant associations between serum albumin level versus total WBC count (p < 0.0001), acute kidney injury (AKI; p = 0.009), bleeding diathesis (p < 0.0001), and occurrence of pregnancy miscarriage (p < 0.0001). CONCLUSION: There is a baseline hypoalbuminaemia and reversal of albumin-to-globulin ratio among confirmed LF infected patients. Based on these findings, the serum level of albumin and albumin-to-globulin ratio at presentation may serve as simple early biomarkers to identify patients at high risk for a complicated clinical course of disease. This study also reveals that those hospitalized LF infected patients with hypoalbuminemia and/or reversal of albumin-to-globulin ratio tend to have leucocytosis and experience prolonged duration of illness.

Prevalence and outcome of Lassa fever among hospitalized patients in Ebonyi State, Nigeria, 2018-2019.

Lassa fever (LF) is a viral hemorrhagic illness endemic in West Africa. Annually, about 300,000-500,000 people are being infected, with about 5000 deaths. Symptoms of LF include high grade fever, headache, malaise, abdominal pain, vomiting, diarrhea, or sore throat. Terminal features may include bleeding from all orifices (mouth, nose, ear, anus and vagina), facial and neck oedema or pleural effusion. People of all ages, gender, and occupations were included in this study. A total of 440 patients' samples and Bio data were used for this study. The samples were analyzed for Lassa fever virus RNA using Real Time Reverse Transcriptase Polymerase Chain Reaction. The data obtained were analyzed using SPSS 20.0 and version 7 of Epi-Info statistical software. Analysis of these samples showed LASV prevalence of 25.7%. Chi-square analysis (p ≤ 0.05) showed that LASV infection does not depend on age, gender, or occupation. Our research re-emphasized the fact that LASV is a serious cause of fatality in humans. Our data showed that among 327 negative patients, 19 died. On the contrary, 113 LASV confirmed positive cases had 42 deaths. This result is highly significant. More so, Lassa fever disease outcome was compared across gender. There was no significant difference between the two genders. Death or recovery from LF infection does not depend on sex. However, recovery from LF significantly depends on age of the patient. Fatal outcome is significantly higher among adults/elderly. We aim to raise awareness to the recurrence of LASV in Ebonyi State and urgent need for other medical interventions, including other therapeutic measures, and possible vaccine production, considering the impact of this virus.

Knowledge and Practices of Health-Care Waste Management among Health Workers in Lassa Fever Treatment Facility in Southeast Nigeria.

BACKGROUND: The threat of endemic, emerging, and reemerging infectious diseases, especially the viral hemorrhagic fevers demands effective health-care waste management (HCWM) among health-care workers. The study was intended to assess the knowledge and practices of HCWM among the cleaning staff in a Lassa fever (LF) treatment facility. MATERIALS AND METHODS: This was a cross-sectional descriptive study of 234 cleaning staff of Federal Teaching Hospital Abakaliki recruited by systematic random sampling. Data collection was with semi-structured questionnaires. Knowledge and practices of respondents were assessed using cutoff score of 75%; score of 75% and above being interpreted as good and <75% as poor. Data were analyzed using Epi™ Info Version 7.2. RESULTS: There were 177 (75.6%) female and 57 (24.4%) male cleaning staff with a mean age of 33.4 years (±8.3). Among all the respondents, 18 (7.7%) had no formal education, while others had varying levels of education (primary, 43 [18.4%]; secondary, 133 [56.8%]; tertiary, 40 [17.1%]). Only 134 (57.3%) of the respondents had ever been trained on HCWM, of which 77 (57.5%) of them were trained in 2018. The proportion of respondents with good knowledge of HCWM was 41.5%. In addition, only 83 (35.5%) properly categorized the body parts, body fluids, and fetuses as pathological waste. About one-third, 77 (33.3%), had knowledge of steps in HCWM and 45.3% knew of diseases transmitted through health-care waste with 171 (62.8%) identifying LF as one of the diseases. The proportion of respondents with good practices of HCWM was 53.9% with only 131 (56.0%) segregating waste in specified color-coded containers. Among the factors examined, none was significantly associated with knowledge and practice of participants on HCWM. CONCLUSION: The proportions of the cleaning staff with good knowledge and practices of HCWM were low. There is a need to train and retrain hospital staff on proper HCWM as well as need for proper supervision and monitoring.

Knowledge of antibiotic use and resistance among students of a medical school in Nigeria.

Background: Antimicrobial resistance presents a growing concern worldwide. Medical students are potential antimicrobial prescribers and stewards following graduation as doctors. The aim of this study was to assess the knowledge regarding antibiotic use and resistance among pre-final year and final year medical school students of Ebonyi State University, Nigeria. Methods: A cross-sectional study was conducted among all the 184 pre-final and final year medical students of the College of Medicine at Ebonyi State University, Nigeria. Information was collected in April 2018 using a semi-structured, self-administered questionnaire and data were analysed with Epi-Info Version 7.2. Analytical decisions were considered significant at P < 0.05. Results: Respondents were mostly males (62.5%), aged 20-29 years (68.9%) with 60.9% of them in the final year class. Eighty-seven percent of them desired more education on antibiotic use and resistance. Majority 119 (64.7%) respondents had good knowledge of antibiotic use and resistance, however, 39% incorrectly answered that bacteria cause common cold. Only 103 (56.0%) of them had positive practice of antibiotic use. While 8.2% of respondents always consulted a doctor before starting an antibiotic. 37.2% of them never discarded their remaining leftover medications. Knowledge was associated with respondent's gender (P=0.035) while practice was associated with the class of study (P<0.001). Conclusion: There was good knowledge of antibiotic use and resistance, however, practice levels were poor. There is need to enrich existing courses and training about antibiotic use in the curriculum of the medical schools with more emphasis on antimicrobial stewardship.

Point prevalence survey of antimicrobial prescription in a tertiary hospital in South East Nigeria: A call for improved antibiotic stewardship.

OBJECTIVES: Antimicrobial prescribing practices and use contribute to the growing threat of antimicrobial resistance (AMR) to global health. Information on antimicrobial prescribing and use are lacking in most developing countries, including Nigeria. This information is crucial for antimicrobial stewardship programmes, an effective tool in minimising AMR. This study was performed to gather baseline information on antimicrobial prescribing practices in Nigeria. METHODS: A cross-sectional survey was conducted on all inpatients of a tertiary hospital in South East Nigeria. All patients on admission on the day of the survey formed the study population. A standardised questionnaire, web-based data entry and validation process designed by the University of Antwerp, Belgium, were adopted. Information on basic patient demographics, antimicrobial agents used, indication for treatment, laboratory data prior to treatment and stop/review date was collected. RESULTS: Of 220 inpatients surveyed, 78.2% were receiving at least one antimicrobial agent. The highest prevalence of antimicrobial use was in the ICU (100%), adult surgical ward (82.9%) and paediatric medical ward (82.9%). Agents used were mainly third-generation cephalosporins (ceftriaxone 25.1%) and nitroimidazole (metronidazole 24.6%). Antimicrobial prescription was empirical (91.1% in medical wards, 96.8% in surgical wards and 100% in ICU). There was limited use of guidelines but clear documentation of stop/review dates and reasons for antimicrobial use. CONCLUSION: Although a majority of antimicrobial prescriptions were made with indications, they were mostly prescribed empirically and the majority of prescriptions were parenteral formulations. There is a need to develop antibiotic guidelines, to educate prescribers on antimicrobial stewardship and to encourage targeted prescription.