Innovative strategies developed to mitigate the impact of COVID-19 pandemic on polio surveillance in Nigeria, 2020.

Introduction: following the spread of the COVID-19 pandemic to Nigeria, the Federal Government of Nigeria restricted human and vehicular movements to curb the spread of the disease. This action had a negative impact on Acute Flaccid Paralysis (AFP) surveillance, with a resultant reduction in the number of AFP cases reported. This paper describes the impact of the COVID-19 pandemic on poliovirus surveillance in Nigeria and the proactive interventions by Nigeria´s polio program to mitigate the impact of COVID-19 on polio surveillance. Methods: nine innovative strategies were implemented in all 774 Local Government Areas (LGA) of the 36 states and Federal Capital Territory (FCT) of the country. These strategies were developed by the national surveillance officers and operationalized by sub-national surveillance officers with different strategies starting at different epidemiological weeks from week 14 to 23, 2020. Many of the strategy innovations were technology-based and included: the use of mobile phones to send the AFP case definition and video by WhatsApp or by SMS, the use of state-specific toll-free numbers and Mobile Telephone Network (MTN) (mobile service provider) CallerfeelTM to community informants (CI) who were the main targets of the interventions to increase case detection and reporting. Others included the use of abridged e-surveillance integrated supportive supervision (ISS) checklists, virtual monthly DSNO meetings, and batched AFP stool specimen transportation network. Results: compared to the same period in 2019, the cumulative rate of AFP case detection and reporting had gradually declined from 39.1% in January to 16.7% before the commencement of the interventions in week 20, 2020. However, the detection and reporting increased by 57.% from week 20 to week 47 compared to the same period in 2019. This is because with COVID-19, hospital visitation dropped, and the sick remained in the communities, so the CI network was relied on to detect and report AFP cases. The cumulative proportion of AFP cases reported by community informants as of week 47 increased from 13% in 2018 to 21% in 2020. This indicates an increase of 38%. Thirty-five AFP cases were detected and reported using the MTN Caller Feel strategy, while 15 cases were reported through state-specific toll-free numbers. Conclusion: the implementation of the innovative strategies was able to mitigate the low AFP case detection and reporting observed at the initial stage of the COVID-19 pandemic. The use of technology facilitated reaching the CI network, which was more instrumental in detecting and reporting the cases.

Implementing a robust adverse event of special interest surveillance for novel oral polio vaccine type 2 rollout, Nigeria, March-July 2021.

Introduction: novel oral poliovirus vaccine type 2 (nOPV2), designed to be more genetically stable than Sabin-strain oral poliovirus vaccine type 2 (mOPV2), is a new and key component of the Global Polio Eradication Initiative's strategy to combat outbreaks of circulating vaccine-derived poliovirus type 2 (cVDPV2). The World Health Organization´s (WHO´s) emergency use listing (EUL) requires extensive safety monitoring for Adverse Event of Special Interest (AESI) in its use. We implemented AESI active surveillance to monitor the safety of the nOPV2 in Nigeria. Methods: a cross-sectional assessment was conducted in Nigeria during March-June 2021 in 117 local government areas (LGAs) across 6 states and the Federal Capital Area with confirmed cVDPV2 transmission. We conducted active searches for nOPV2 AESI in all health facilities. Suspected events were ascertained, and vaccination and clinical data abstracted. Events were classified using WHO causality assessment algorithm. Data were analyzed using Epi info7. Results: total of 234 adverse events were reported after 21,997,300 doses of nOPV2 were administered, giving a crude reported incidence of 1 in 94,000 doses of nOPV2. Altogether, 221 of the 234 (94%) adverse events were classified. For 166 AESI ascertained to occur following a dose of nOPV2, the corrected crude incidence rate was 1 in 133,000 doses; 4 of the adverse events, were classified as consistent with casual association with nOPV2 vaccination. Conclusion: we found that nOPV2 had a low incidence of AESI following nOPV2 campaigns and no new or unexpected adverse event was reported. Safety monitoring should be sustained for early detection of signals and uncommon adverse events.

Historical reconstruction of inaccessibility status in Local Government Areas (LGAs) of Borno and Yobe States, Nigeria, 2010-2020.

Introduction: ultimately detected in 2016, wild poliovirus (WPV) transmission continued undetected after 2011 in Northeast Nigeria Borno and Yobe States in security-compromised areas, inaccessible due to armed insurgency. Varying inaccessibility prevented children aged <5 years in these areas from polio vaccination interventions and surveillance, while massive population displacements occurred. We examined progress in access over time to provide data supporting a very low probability of undetected WPV circulation within remaining trapped populations after 2016. Methods: to assess the extent of inaccessibility in security-compromised areas, we obtained empirical historical data in 2020 on a quarterly and annual basis from relevant polio eradication staff for the period 2010-2020. The extent of access to areas for immunization by recall was compared to geospatial data from vaccinator tracking. Population estimates over time in security-compromised areas were extracted from satellite imagery. We compared the historical access data from staff with tracking and population esimates. Results: access varied during 2010-2020, with inaccessibility peaking during 2014-2016. We observed concurrent patterns between historical recalled data on inaccessibility and contemporaneous satellite imagery on population displacements, which increased confidence in the quality of recalled data. Conclusion: staff-recalled access was consistent with vaccinator tracking and satellite imagery of population displacments. Despite variability in inaccessibility over time, innovative immunization initiatives were implemented as access allowed and surveillance initiatives were initiated to search for poliovirus transmission. Along with escape and liberation of residents by the military in some geographic areas, these initiatives resulted in a massive reduction in the size of the unvaccinated population remaining resident.

Data management needs assessment for the scale-up of district health information system and introduction of routine (essential) immunization module in Bauchi State, Nigeria, 2015.

Introduction: the National Primary Health Care Development Agency, African Field Epidemiology Network, United States Centers for Disease Control and Prevention and the Bill and Melinda Gates Foundation are implementing a Routine Immunization (RI) Module as part of their Routine Health Data Management System based on the 2013 - 2015 Accountability Framework for RI in Nigeria. To inform planning and evidence-based decision making, a data management needs assessment was conducted in Bauchi state which was one of the states selected for the deployment of the DHIS2 RI module. Methods: desk reviews were conducted, and a semi-structured questionnaire was administered in four Local Government Areas (LGAs) in Bauchi state that were selected based on the initial evaluation of the performance of all 20 Bauchi LGAs. Ganjuwa and Shira were selected as high-performing LGAs and Alkaleri and Bogoro as low-performing LGAs. Four Health Facilities (HF) were selected in each LGA based on rural or urban classification, type of HFs (private or public), security and accessibility. Results: local Immunization Officers (LIOs) prepare monthly reports in high-performing LGAs, and Community Health Care workers are mostly (69%) responsible for report compilation at the HFs. Shira and Alkaleri met 77% and 44% of training indicator targets, respectively, in the previous 12 months. Data recording and reporting was the type of training received the most by health facility personnel. Functioning refrigerators were in all visited LGAs, working thermometer and updated temperature monitoring charts were available in all the cold chain stores. However, no health facility reported having available computers for data-related activities. Conclusion: this assessment provided an improved understanding of the Bauchi state Routine Health Data Management System and informed the content of the state-wide scale-up.

A rapid qualitative assessment of barriers associated with demand and uptake of health facility-based childhood immunizations and recommendations to improve immunization service delivery in Sokoto State, Northwest Nigeria, 2017.

Introduction: This rapid qualitative assessment aimed to understand factors associated with persistent low vaccination demand and uptake, and recommendations to improve health facility-based childhood immunization services in Sokoto State, Nigeria. Methods: In 2017, 20 focus group discussions and 16 in-depth interviews were conducted with administrative personnel, healthcare workers, caregivers, and community influencers across three local government areas in Sokoto state, Northwest Nigeria. Participants were purposefully selected to capture a range of perspectives regarding access to health services, campaign- and facility-based immunizations, confidence in immunizations, and recommendations to improve childhood immunization uptake. Results: One hundred and ninety-three individuals participated in the assessment. Commonly reported barriers to receiving childhood immunizations include: inadequacy of health services to meet community needs, preference for campaign vs. facility-based immunizations, the negative influence of rumors and misinformation, and opposition to vaccines among male heads of households. Recommendations to improve uptake of childhood immunizations include: improving immunization service delivery in health facilities, involving community leaders in building demand for immunization, and providing access to free health services and non-cash incentives. Conclusion: Rapid assessment results highlight community, facility, and administrative barriers associated with low demand for and uptake of health facility-based childhood immunizations and offer recommendations to improve immunization services in Sokoto state, Nigeria. Findings demonstrate the persistence of service and supply side barriers such as infrastructure and personnel issues, but also highlight the influence of behavioral factors such as low prioritization of receiving childhood immunizations, misinformation, and gender dynamics on whether communities accept or seek out immunization services.

Pilot implementation of a routine immunization module of the district health information system version 2 in Kano State, Nigeria, 2014 - 2015.

Introduction: Timely and accurate data are necessary for informing sound decision-making and developing effective routine immunization (RI) programs. We launched a pilot project in Kano State to strengthen routine immunization (RI) data reporting through the immunization module of the District Health Information System version 2 (DHIS2). We examined the completeness and timeliness of reporting monthly RI data one year before and one year after DHIS2 module pilot in the State. Methods: The first phase of the DHIS2 RI module pilot in Kano included training on RI data tools in November 2014 and in January 2015 for 36 state and zonal personnels, 276 local government area (LGA) personnel, and 2,423 health facility (HF) staff. A RI-focused dashboard to display core RI accountability framework indicators, such as completeness and timeliness of reporting, planned immunization sessions conducted, coverage and dropout was implemented. Report completeness was ratio of submitted reports to number of health facilities while report timeliness was ratio of reports on the DHIS2 by 14th of the month to number of expected. Results: Completeness of data reporting increase from 70% in 2014 to 87% in 2015, while timeliness of reporting increase from 64% to 87% over the same period. Challenges encountered during the implementation process included limited access to internet, power outages, health workers strike, staff attrition and competing state activities. Conclusion: The pilot implementation of the DHIS2 immunization module in Kano State led to modest improvement in the reporting of RI services. Several lessons learned were used to guide scale-up to other states in the country.

National Stop Transmission of Polio Program support for polio supplemental immunization activities in Nigeria 2012-2016: deployment of management support team.

Introduction: to support polio eradication activities in Nigeria, in 2012 the National Polio Emergency Operation Center (NEOC) created the Management Support Teams (MST) to address gaps in the quality of supervision of polio vaccination teams. The National Stop Transmission of Polio (NSTOP) Program supported the polio eradication activities by deploying trained supervisors as part of the MST for polio and non-polio immunization campaigns. Methods: trained MST members were deployed approximately 4 days before the start of the campaign to participate in pre-implementation activities and supervise vaccination teams during campaigns. Terms of reference (TOR) developed by NEOC was provided to MST members to guide their activities. Qualified MSTs that met pre-determined criteria were selected and deployed to the field to support pre, intra and post campaigns activities. Results: a pool of over 400 MST personnel have been identified, trained, and repeatedly deployed from 2012 till 2016. The number of deployed MST personnel rose from 40 per campaign in October 2012 to 342 in May 2016. Of these, 270 (79%) MST personnel were deployed to 11 polio high-risk states of northern Nigeria, where campaigns are conducted between eight and ten times yearly as planned by NEOC. For measles campaigns, about 300 (75%) MST personnel were deployed for the one-off northern and southern campaigns in 2016. The results of clustered Lot Quality Assurance Sampling (LQAS) post-campaign vaccination coverage surveys, a measure of campaign quality, of which introduction into the polio program coincided with deployment of MSTs, showed improvement over time, from 10% (very poor quality) in February 2012 to about 90% (good quality) in December 2016. Conclusion: the deployment of MST personnel increased the number of trained supervisors in the field, frequency of supervisory visits and had a positive impact on the quality of polio campaigns.

Strengthening facility-based immunization service delivery in local government areas at high risk for polio in Northern Nigeria, 2014-2015.

Introduction: The National Stop Transmission of Polio (NSTOP) program was created in 2012 to support the Polio Eradication Initiative (PEI) in Local Government Areas (LGAs) at high risk for polio in Northern Nigeria. We assessed immunization service delivery prior to the commencement of NSTOP support in 2014 and after one year of implementation in 2015 to measure changes in the implementation of key facility-based Routine Immunization (RI) components. Methods: The pre- and post-assessment was conducted in selected health facilities (HFs) in 61 LGAs supported by NSTOP in 5 states. A standardized questionnaire was administered to the LGA and HF immunization staff by trained interviewers on key RI service delivery components. Results: At the LGA level, an increase was observed in key components including availability of updated Reach Every Ward (REW) micro-plans with identification of hard to reach settlements (65.6% baseline, 96.8% follow-up, PR = 1.5 (95% CI 3.4 - 69.8), vaccine forecasting (77.1% baseline, 93.5% follow-up, PR =1.2 (95% CI 1.8 - 13.8), and timely delivery of monthly immunization reports (73.8% baseline, 90.2% follow-up; PR =1.2 (95% CI 1.2 - 9.0). At the HF level, there was an increase in percentage of HFs with written supervisory feedback (44.5% baseline, 82.5% follow-up, PR = 1.8 (95% CI 4.7 - 7.3), written stock records (66.5% baseline, 87.9% follow-up, PR = 1.3 (95% CI 2.9 - 4.7) and updated immunization monitoring charts (76.3% baseline, 95.6% follow-up, PR = 1.3 (95% CI 4.6 - 9.9). Conclusion: We observed an improvement in key RI service delivery components following implementation of NSTOP program activities in supported LGAs.

Revelation of an important weakness in polio elimination efforts in Nigeria: a descriptive cross-sectional study of nomadic dynamics in Sokoto and Taraba States, May 2013.

Introduction: Operational gaps in the Global Polio Eradication Initiative implementation had been partly responsible for inadequate population immunity and the continued transmission of wild poliovirus in Nigeria before the African Region was declared polio-free in 2020. Missed opportunities to provide services in nomadic populations due to frequent mobility, lack of inclusion in microplans and the remoteness of their settlements were the major challenges. During May 2013 we conducted immunization outreach to nomadic and other underserved communities in Rabah LGA, Sokoto state, and Ardo Kola LGA, Taraba state, in Nigeria to identify and vaccinate children missed during supplemental immunization activities while identifying missed acute flaccid paralysis cases. Methods: An enumeration checklist and data collection instruments on Android cell phones were used to capture socio-demographic data and GPS coordinates on nomadic settlements, households, number of children aged <5 years, children previously missed for vaccination and their locations. Local guides led trained enumerators to underserved communities for the enumeration and vaccination. Data were analyzed using Microsoft Excel 2007. Results: A total of 324 settlements were listed for the two states, and 111 (34.3%) of these were identified as missed when compared with micro-planning for the most recent SIA. In these settlements, 3,533 households and 9,385 children aged <5 years were listed. We administered oral poliovirus vaccine to all 1,946 missed children during the recent or any supplemental immunization activities. Of these, 527 (27.1%) had never been vaccinated. We found no missed acute flaccid paralysis cases. Conclusion: Nomadic populations continue to be underserved, especially for vaccination services. This results in pockets of populations with low herd immunity and increased risk for poliovirus transmission. Community leaders and nomadic settlements should be included in the micro-planning of all supplemental immunization activities to ensure all children receive vaccination services.

Enhancing acute flaccid paralysis surveillance system towards polio eradication: reverse cold chain monitoring in Nigeria, 2017 to 2019.

Introduction: Highly sensitive acute flaccid paralysis (AFP) surveillance is critical for detection of poliovirus circulation and documentation for polio-free certification. The reverse cold chain (RCC) is a system designed to maintain stool specimens in appropriate temperature for effective detection of poliovirus in the laboratory. We monitored the RCC of AFP surveillance in Nigeria to determine its effectiveness in maintaining viability of enterovirus. Methods: A descriptive cross-sectional study was conducted from November 2017 to December 2019. We included AFP cases from 151 Local Government Areas and monitored RCC of paired stool specimens from collection to arrival at laboratories. The national guideline recommends RCC temperature of +2 to +8°C and a non-polio enterovirus (NPENT) detection rate of ≥10%. We analyzed data with Epi Info 7, and presented results as frequencies and proportions, using Chi-square statistic to test for difference in enterovirus isolation. Results: Of the 1,042 tracked paired stool specimens, 1,038(99.6%) arrived at the laboratory within 72 hours of collection of second specimen, 824(79.1%) were maintained within recommended temperature range, and 271(26%) yielded enteroviruses: 200(73.8%) NPENT, 66(24.4%) Sabin, 3(1.1%) vaccine derived poliovirus type 2 and 2(0.7%) mixture of Sabin and NPENT. The NPENT and Sabin rates were 19.2% and 6.7% respectively. Twenty-five percent of 824 specimens maintained within recommended temperature range, compared with 29.8% of 218 specimens with temperature excursion yielded enteroviruses (P=0.175). Conclusion: the RCC of AFP surveillance system in the study area was optimal and effective in maintaining the viability of enteroviruses. It was unlikely that poliovirus transmission was missed during the intervention.

Prioritization of zoonotic diseases of public health significance in Nigeria using the one-health approach.

Nigeria, with a population of over 190 million people, is rated among the 10 countries with the highest burden of infectious and zoonotic diseases globally. In Nigeria, there exist a sub-optimal surveillance system to monitor and track priority zoonoses. We therefore conducted a prioritization of zoonotic diseases for the first time in Nigeria to guide prevention and control efforts. Towards this, a two-day in-country consultative meeting involving experts from the human, animal, and environmental health backgrounds prioritized zoonotic diseases using a modified semi-quantitative One Health Zoonotic Disease Prioritization tool in July 2017. Overall, 36 of 52 previously selected zoonoses were identified for prioritization. Five selection criteria were used to arrive at the relative importance of prioritized diseases based on their weighted score. Overall, this zoonotic disease prioritization process marks the first major step of bringing together experts from the human-animal-environment health spectrum in Nigeria. Importantly, the country ranked rabies, avian influenza, Ebola Virus Disease, swine influenza and anthrax as the first five priority zoonoses in Nigeria. Finally, this One Health approach to prioritizing important zoonoses is a step that will help to guide future tracking and monitoring of diseases of grave public health importance in Nigeria.

Determinants of improved data consistency across routine immunization data tools for health facilities in Kano State, Nigeria.

INTRODUCTION: in this study, determinants of improved data consistency for routine immunization information at health facilities was measured to identify associated factors. METHODS: between June and August 2015, 1055 HFs were visited across 44 Local Government Areas in Kano state. We assessed data consistency, frequency of supportive supervision visits, availability of trained staff and attendance to monthly LGA RI review meetings. We compared RI monthly summary forms (MSF) versus national health management information system summary form (NHMIS) and vaccine management form 1a (VM1a) versus HF vaccine utilization summary monthly summary (HFVUM) for consistency. Data consistency at HF was determined at <+10% between number of children reportedly immunized, and doses of vaccine opened using 3 antigens (BCG, Penta and Measles). Levels of discrepancy <10% were considered as good data consistency. Bivariate and multivariate analysis used to determine association. RESULTS: data Consistency was observed in 195 (18.5%) HFs between (MSF vs NHMIS) and 90 (8.5%) HFs between (VM1a vs HFVUM). Consistency between MSF vs NHMIS was associated with receiving one or more SS visits in the previous month (p=0.001), data collection tools availability (p=0.001), recent attendance to monthly LGA RI review meeting and availability of trained staff. Data consistency between VM1a form and the HF VU summary was associated with a recent documented SS visit (p=0.05) and availability of trained staff (p=0.05). CONCLUSION: low level of data consistency was observed in Kano. Enhanced SS visits and availability of trained staff are associated with improved data quality.

Determinants of perinatal mortality in public secondary health facilities, Abuja Municipal Area Council, Federal Capital Territory, Abuja, Nigeria.

INTRODUCTION: in Nigeria, perinatal mortality rate remains high among births at the health facility. Births occur majorly at the secondary healthcare level in Abuja Municipal Area Council (AMAC) of the Federal Capital Territory (FCT). Identifying factors influencing perinatal deaths in this setting would inform interventions on perinatal deaths reduction. We assessed perinatal mortality and its determinants in public secondary health facilities in AMAC. METHODS: delivery and neonatal data from two selected public secondary health facilities between 2013 and 2016 were reviewed and we extracted maternal socio-demographics, obstetrics and neonatal data from hospital delivery, newborns´ admissions and discharge registers. Data were analyzed using descriptive statistics and Cox proportional hazard models (α = 5%). RESULTS: perinatal mortality rate was 129.5 per 1000 births. Asphyxia 475 (34.0%), neonatal infection 279 (20.0%) and prematurity 242 (17.3%) accounted for majority of the 1,398 perinatal deaths. Unbooked status [aHR = 1.8 (95% CI 1.4 - 2.2)], antepartum haemorrhage [aHR = 2.8 (95% CI 1.2 - 6.7)], previous perinatal death [aHR = 2.3 (95% CI 1.7 - 3.1)] and maternal age ≥ 35 years [aHR= 1.4 (95% CI 1.0 - 1.8)] were associated with increased risk of perinatal death. CONCLUSION: perinatal mortality in the studied hospitals was high. Determinants of perinatal death were unbooked antenatal care (ANC) status, antepartum haemorrhage, previous perinatal death and high maternal age. Reducing perinatal deaths would require improving antenatal care attendance with healthcare staff identifying and targeting women at risk of pregnancy complications.

Temporal trend of measles cases and impact of vaccination on mortality in Jigawa State, Nigeria, 2013-2017: a secondary data analysis.

INTRODUCTION: Measles is a highly infectious vaccine-preventable viral disease that mostly affects children less than five years old. Jigawa located in the north-west zone has the highest burden of measles in Nigeria. We reviewed Jigawa State measles surveillance data to identify measles trend and factors associated with mortality. METHODS: We conducted a secondary data analysis of measles specific integrated disease surveillance and response data for Jigawa State from January 2013 to December 2017. We extracted relevant variables and analyzed data using descriptive statistics and logistic regression model (α = 0.05). We estimated seasonal variation using an additive time series model. RESULTS: A total of 6,214 cases were recorded with 1038 (16.7%) confirmed by laboratory investigation. Only 1,185 (19.7%) had at least one dose of measles vaccine. Age specific attack and fatality rates were highest among children under the age of five years (503/100,000 and 1.8% respectively). The trend showed a decrease in number of cases across all the years. Seasonal variation existed with cases peaking in the first quarter. The likelihood of mortality associated with measles was higher among cases who had no vaccination (AOR = 4.7, 95% CI: 2.9-7.5) than those who had at least one dose of measles vaccine. CONCLUSION: There was a decrease in the trend of measles cases, however, the vaccination coverage was very low in Jigawa State. Receiving at least one dose of measles vaccine reduces mortality among the cases. Strengthening routine immunization will reduce number of cases and mortality associated with the disease.

Implementing the routine immunisation data module and dashboard of DHIS2 in Nigeria, 2014-2019.

In 2010, Nigeria adopted the use of web-based software District Health Information System, V.2 (DHIS2) as the platform for the National Health Management Information System. The platform supports real-time data reporting and promotes government ownership and accountability. To strengthen its routine immunisation (RI) component, the US Centers for Disease Control and Prevention (CDC) through its implementing partner, the African Field Epidemiology Network-National Stop Transmission of Polio, in collaboration with the Government of Nigeria, developed the RI module and dashboard and piloted it in Kano state in 2014. The module was scaled up nationally over the next 4 years with funding from the Bill & Melinda Gates Foundation and CDC. One implementation officer was deployed per state for 2 years to support operations. Over 60 000 RI healthcare workers were trained on data collection, entry and interpretation and each local immunisation officer in the 774 local government areas (LGAs) received a laptop and stock of RI paper data tools. Templates for national-level and state-level RI bulletins and LGA quarterly performance tools were developed to promote real-time data use for feedback and decision making, and enhance the performance of RI services. By December 2017, the DHIS2 RI module had been rolled out in all 36 states and the Federal Capital Territory, and all states now report their RI data through the RI Module. All states identified at least one government DHIS2 focal person for oversight of the system's reporting and management operations. Government officials routinely collect RI data and use them to improve RI vaccination coverage. This article describes the implementation process-including planning and implementation activities, achievements, lessons learnt, challenges and innovative solutions-and reports the achievements in improving timeliness and completeness rates.

Strengthening service integration for effective linkage of HIV-positive mothers to antiretroviral treatment: a cross-sectional study in two military health facilities in Kaduna, Nigeria, 2014.

INTRODUCTION: strong PMTCT-ART service linkages ensure continuity of care for healthier mothers and children born HIV free. Program data showed weak PMTCT- ART linkages in military health facilities. We conducted a study to assess the PMTCT-adult ART service linkage in two Nigerian military health facilities in Kaduna State. METHODS: we conducted a cross-sectional study using mixed methods (interviews and FGDs) in 44 Nigeria Army Reference Hospital (NARH) and 1 Division Hospital, Kaduna. We studied 372 HIV-positive mothers after a delivery of their babies, referred for ART services from January 2009 to December 2013. We conducted FGDs among ANC, PMTCT and ART clinics staff. We analysed data using descriptive and inferential methods. A p-value of < 0.05 was considered significant with 95% confidence intervals (CI) for estimates. RESULTS: of the 372 respondents studied, 320 (86%) accessed PMTCT services from the 44 NARH. Most respondents (206,55.4%) respondents aged < 25 years. One in six (16.7%) respondents had no record of referral. Delivering baby in a separate facility from where PMTCT services were accessed, increased the likelihood of not accessing ART services (odd ratio [OR]: 6.7, 95% CI= 3.3 -13.6). The qualitative study identified poor service integration between PMTCT and ANC clinics. CONCLUSION: the key factors hindering PMTCT-ART linkage in military health facilities included poor service integration, clients delivering of a baby in a facility separate from where PMTCT services were accessed. The Ministry of Defence HIV programme should strengthen ANC-PMTCT-ART service integration through a centrally coordinated client information management system.

Measles outbreaks and Supplemental Immunization Activities (SIAs): the Gwagwalada experience, Abuja 2015.

INTRODUCTION: In November 2015 a measles outbreak was detected in several clustered settlements during the Northern Measles Supplementary Immunization Activities (SIAs) campaign in Gwagwalada, Nigeria, a measles outbreak was detected. Six weeks later another outbreak with 17 cases was reported in a different settlement in the same area council in December 2015 and January 2016. An outbreak investigation was initiated to characterize the outbreak in terms of time and person and implement prevention and control measures. METHODS: Suspected cases were defined as any person in Gwagwalada with onset of fever and rash between 1st November 2015 and 12th January 2016. Probable cases were defined as suspected cases with 3 days of rash or known exposure to someone with laboratory-confirmed measles. Confirmed case patients were defined as suspected or probable cases with Koplik spots or positive titer for immunoglobulin (Ig) M antibody. We conducted house to house case search, contact tracing and reviewed hospital records at the health facilities to determine the socio-demographic characteristics, clinical presentation and vaccination status of the cases. RESULTS: Active case search between November 2015 and January 2016 as well as record review from January 2015 to January 2016 showed that there were 109 suspected and 10 confirmed case patients. We identified 66 cases during the first reported outbreak with a case fatality rate of 6% (4 deaths) while 17 cases were identified 6 weeks later. The epidemic curve indicated a person-to-person transmission. CONCLUSION: There had been cases of measles from January 2015 to November 2015 prior to the reported measles outbreak. However there was an unusual increase in the number of measles cases during the measles SIAs in communities where children were missed. Vaccination of all eligible children in the affected wards was carried out. The area council authorities and primary healthcare team need to create awareness on the importance of measles vaccination and ensure that these communities are targeted and covered during subsequent SIAs.

Prevalence and correlates of intimate partner violence, before and during pregnancy among attendees of maternal and child health services, Enugu, Nigeria: mixed method approach, January 2015.

INTRODUCTION: Intimate Partner Violence (IPV) is an under-reported public health problem. This study determined the prevalence of IPV and types of IPV, complications and factors associated with IPV among women accessing health services. METHODS: we conducted a cross-sectional survey of 702 women accessing maternal and child health services in Enugu State, Nigeria using multi-stage sampling technique. Quantitative data was collected using semi-structured questionnaire, qualitative data by key informant interview (KII). We analysed data using descriptive statistics, bivariate and multivariate logistic regression analysis. The level of statistical significance was set at p-value < 0.05. Qualitative data was analysed using thematic content analysis. RESULTS: mean age of respondents was 27.71 ± 5.14 years and 654 (93.2%) were married. Prevalence of IPV, a year before last pregnancy, was 307 (43.7%) and during last pregnancy was 261 (37.2%). Frequent involvement in physical fights with other men, controlling behaviour and younger aged partners (< 40 years) were independent predictors of IPV experience both before and during pregnancy. Independent predictors of IPV experience before and during pregnancy were younger aged partners (< 40 years). [Adjusted Odds Ratio AOR 1.72; 95% confidence interval (CI) = 1.17, 2.53], partner having controlling behaviour AOR 2.24; 95% C.I=1.51-3.32) and Partner's frequent involvement in physical fights (AOR 2.29; 95% C.I = 1.43-3.66). Having a male child and married/cohabiting were protective against violence. KII revealed poverty, lack of education and infidelity as common triggers of IPV. CONCLUSION: the prevalence of IPV and types of IPV was high and the predisposing factors of IPV in Enugu were multifactorial. Couple counselling sessions that focus on non-violence conflict resolution techniques is crucial to end IPV.

Comparison of Micro-Census Results for Magarya Ward, Wurno Local Government Area of Sokoto State, Nigeria, with Other Sources of Denominator Data.

Routine immunization coverage in Nigeria is suboptimal. In the northwestern state of Sokoto, an independent population-based survey for 2016 found immunization coverage with the third dose of Pentavalent vaccine to be 3%, whereas administrative coverage in 2016 was reported to be 69%. One possibility driving this large discrepancy is that administrative coverage is calculated using an under-estimated target population. Official population projections from the 2006 Census are based on state-specific standard population growth rates. Immunization target population estimates from other sources have not been independently validated. We conducted a micro-census in Magarya ward, Wurno Local Government Area of Sokoto state to obtain an accurate count of the total population living in the ward, and to compare these results with other sources of denominator data. We developed a precise micro-plan using satellite imagery, and used the navigation tool EpiSample v1 in the field to guide teams to each building, without duplications or omissions. The particular characteristics of the selected ward underscore the importance of using standardized shape files to draw precise boundaries for enumeration micro-plans. While the use of this methodology did not resolve the discrepancy between independent and administrative vaccination coverage rates, a simplified application can better define the target population for routine immunization services and estimate the number of children still unprotected from vaccine-preventable diseases.

Blood donor safety, prevalence and associated factors for cytomegalovirus infection among blood donors in Minna-Nigeria, 2014.

INTRODUCTION: human cytomegalovirus (CMV) has remained a cause of morbidity and mortality in pregnancy and immunocompromised patients. CMV is transmissible through blood transfusion. We conducted a descriptive, cross-sectional study to assess blood donor safety and to determine the prevalence and associated factors for CMV infection among blood donors in Minna, Nigeria. METHODS: all consenting blood donors were screened for CMV antibodies (IgM and IgG) using ELISA kit and haematological indices using a haematological analyzer. We administered structured questionnaires to obtain socio-demographic and socio-economic data. Data were subjected to univariate, bivariate and multivariate statistical analyses using Epi Info version 3.5.4. Significant associations were presumed if p < 0.05. RESULTS: a total of 345 participantswere recruited, the majority were males 336 (97.4%). Monthly earnings of majority of the blood donors, 136 (40.6%) ranged from ₦18,000 to ₦35,000. The prevalence of CMV infection was 96.2%. The prevalence of anti-CMV IgG antibodies was 96.2% and that of IgM was 2.6%. Most of the study participants, 274 (79.4%) were family replacement donors. The majority of the blood donors 195 (56.5%) were anaemic (PCV < 36, Hb < 12g/dl). Those with positive CMV were more likely to be of high-income level (OR = 0.32, P = 0.04). CONCLUSION: the seroprevalence of CMV was high with a significant proportion of donors capable of transmitting CMV infection to blood recipients. The majority of the blood donors were anaemic. High income level is associated with CMV infection. Quality of screening for anemia be improved.