A narrative review of evidence to support increased domestic resource mobilization for family planning in Nigeria.

BACKGROUND: Family planning (FP) is an important public health intervention that is proven to reduce unplanned pregnancies, unsafe abortions, and maternal mortality. Increasing investments in FP would ensure stability and better maternal health outcomes in Nigeria. However, evidence is needed to make a case for more domestic investment in family planning in Nigeria. We undertook a literature review to highlight the unmet needs for family planning and the situation of its funding landscape in Nigeria. A total of 30 documents were reviewed, including research papers, reports of national surveys, programme reports, and academic/research blogs. The search for documents was performed on Google Scholar and organizational websites using predetermined keywords. Data were objectively extracted using a uniform template. Descriptive analysis was performed for quantitative data, and qualitative data were summarized using narratives. Frequencies, proportions, line graphs and illustrative chart were used to present the quantitative data. Although total fertility rate declined over time from 6.0 children per woman in 1990 to 5.3 in 2018, the gap between wanted fertility and actual fertility increased from 0.2 in 1990 to 0.5 in 2018. This is because wanted fertility rate decreased from 5.8 children per woman in 1990 to 4.8 per woman in 2018. Similarly, modern contraceptive prevalence rate (mCPR) decreased by 0.6% from 2013 to 2018, and unmet need for family planning increased by 2.5% in the same period. Funding for family planning services in Nigeria comes from both external and internal sources in the form of cash or commodities. The nature of external assistance for family planning services depends on the preferences of funders, although there are some similarities across funders. Irrespective of the type of funder and the length of funding, donations/funds are renewed on annual basis. Procurement of commodities receives most attention for funding whereas, commodities distribution which is critical for service delivery receives poor attention. CONCLUSION: Nigeria has made slow progress in achieving its family planning targets. The heavy reliance on external donors makes funding for family planning services to be unpredictable and imbalanced. Hence, the need for more domestic resource mobilization through government funding.

Lessons learnt from the management of a case of Lassa fever and follow-up of nosocomial primary contacts in Nigeria during Ebola virus disease outbreak in West Africa.

OBJECTIVE: To describe our experiences in the management of a case of Lassa fever (LF) and follow-up of nosocomial primary contacts during the 2014 Ebola outbreak in West Africa. METHODS: Clinical management of the index case and infection control/surveillance activities for primary contacts are described. Laboratory confirmation was by Lassa virus-specific reverse-transcriptase PCR. RESULTS: A 28-year-old man with a 10-day history of febrile illness was referred to a major tertiary hospital in south-east Nigeria from a city that previously experienced a LF outbreak and was recently affected by Ebola. On observation of haemorrhagic features, clinicians were at a crossroads. Diagnosis of LF was confirmed at a National Reference Centre. The patient died despite initiation of ribavirin therapy. Response activities identified 121 primary contacts comprising 78 (64.5%) hospital staff/interns, 19 (15.7%) medical students, 18 (14.9%) inpatients and 6 (5.0%) relatives. Their mean age was 32.8 ± 6.6 years, and 65.3% were women. Twenty (16.5%) had high-risk exposure and were offered ribavirin as post-exposure prophylaxis. No secondary case of LF occurred. Fatigue (43.8%) and dizziness (31.3%) were the commonest side effects of ribavirin. CONCLUSIONS: Response activities contained nosocomial spread of LF, but challenges were experienced including lack of a purpose-built isolation facility, absence of local Lassa virus laboratory capacity, failure to use appropriate protective equipment and stigmatisation of contacts. A key lesson is that the weak health systems of Africa should be comprehensively strengthened; otherwise, we might win the Ebola battle but lose the one against less virulent infections for which effective treatment exists.

A Systematic Review of Yellow Fever Outbreaks and Public Health Responses in Nigeria.

Background: Yellow fever (YF) outbreaks continue to occur in Nigeria with a high mortality rate despite a well-established mode of transmission and the availability of a potent vaccine. This review is aimed at describing the epidemiology, determinants, and public health responses of yellow fever outbreaks in Nigeria from 1864 to 2020. Methodology: The guidelines for the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) were used to conduct the review from November 2020 to April 2021. PubMed database, WHO library databases, and Google Scholar were used to search for relevant published materials including original and reviewed articles, conference papers and case reports from 1864 to 2020. Results: Forty - eight articles and reports were included in the final reviews. Twenty - three outbreaks were described involving 33,830 suspected, presumptive, or confirmed cases of yellow fever and 8,355 deaths. The outbreaks occurred in every state of Nigeria including the Federal Capital Territory mostly during the rainy season. Low immunity in the population or low vaccination coverage, poor vector control, rainforest or savanna vegetation, rural-urban migration, and imported virus by travelers were common determinants noted. Public health responses have been through, centrally coordinated laboratory support, case management, emergency immunization, vector control, and surveillance. Conclusion: Yellow fever outbreaks have increased in frequency and geographical spread with associated mortality rates. To stem the tide, mass immunization with 17D vaccines is encouraged, planned urbanization with adequate vector control measures enforced, effective case definition, vector surveillance, and effective awareness campaigns should be emphasized.

Food Security Status and Factors Affecting Household Food Security in Enugu State, Nigeria.

INTRODUCTION: In Nigeria, high inflation rates, increasing consumer price index, insurgency, and displacement of households have negatively affected household income expenditures on food resulting in food insecurity. This study aimed at determining the food security status and factors affecting this among households in Enugu state, Nigeria. METHODS: A descriptive cross-sectional study of 800 households in Enugu state, Nigeria. RESULTS: As many as 61.1% of households in Enugu State were found to be food-insecure. The factors influencing food security status were wealth index, belonging to a cooperative society, lack of money to buy food items, and the number of accessible marketplaces. Various coping strategies included skipping meals (77%), reducing quantity of meals (92.6%), purchasing less preferred meals (72.3%) and borrowing food and money (31.3%). CONCLUSION: The prevalence of food-insecure households was high, mostly due to poverty, not belonging to a cooperative society, and few accessible marketplaces. There is a need for economic and political stability that is supportive of households.

Inequities in the use of sulphadoxine-pyrimethamine for malaria prophylaxis during pregnancy in Nigeria.

Background: Intermittent presumptive treatment in pregnancy (IPTp) of malaria using sulfadoxine-pyrimethamine (SP) was introduced in Nigeria in 2005 to reduce the burden of malaria in pregnancy. By 2013, 23% of reproductive aged women surveyed received SP for malaria prevention in their last pregnancy of the past 5 years. This paper highlights geographic and socio-economic variations and inequities in accessing and using SP for malaria prophylaxis in pregnancy in Nigeria, as well as client-related and service delivery determinants. Methods: Secondary data from 2013 Nigeria demographic and health survey (DHS) was used. Sample of 38,948 eligible women were selected for interview using stratified three-stage cluster design. Data obtained from the individual recode dataset was used for descriptive and logistic regression analysis of factors associated with SP use in pregnancy was performed. Independent variables were age, media exposure, region, place of residence, wealth index, place of antenatal care (ANC) attendance and number of visits. Results: Women in the upper three wealth quintiles were 1.33 - 1.80 times more likely to receive SP than the poorest (CI: 1.15-1.56; 1.41-1.97; 1.49-2.17). Women who received ANC from public health facilities were twice as likely (inverse of OR 0.68) to use SP in pregnancy than those who used private facilities (CI: 0.60-0.76). Those who attended at least 4 ANC visits were 1.46 times more likely to get SP prophylaxis (CI: 1.31-1.63). Using the unadjusted odds ratio, women residing in rural areas were 0.86 times less likely to use SP compared to those in urban areas. Conclusions: Inequities in access to and use of SP for malaria prophylaxis in pregnancy exist across sub-population groups in Nigeria. Targeted interventions on the least covered are needed to reduce existing inequities and scale-up IPTp of malaria.

Knowledge, Misperceptions, Preparedness, and Barriers towards Lassa Fever Control among Health Care Workers in a Tertiary Institution in Enugu, Nigeria.

BACKGROUND: Lassa fever outbreaks are common in Nigeria. The study aimed to assess knowledge, misperception, preparedness and barriers towards Lassa fever among health care workers (HCWs) in a tertiary hospital in Enugu. METHODS: A descriptive cross-sectional study among 400 HCWs of a Teaching Hospital in Nigeria. RESULTS: The study showed that 56.5% had fair knowledge while 42.0% and 1.5% had poor and good knowledge, respectively. Over 84% had good risk perception of acquiring Lassa fever while 15.8% had poor risk perception. Only 13% received training on emergency preparedness while 90.3% desired this training. Associations between occupation and knowledge were significant. Barriers to Lassa fever control were non-availability of infection control tools, lack of training on preparedness, absence of local laboratory, and non-availability of ribavirin. CONCLUSION: The study showed poor level of preparedness for Lassa fever and recommended routine training of HCWs on emergency preparedness.

Development of an RT-LAMP assay for the detection of Lassa viruses in southeast and south-central Nigeria.

Lassa virus (LASV) causes Lassa fever (LF), a viral hemorrhagic fever endemic in West Africa. LASV strains are clustered into six lineages according to their geographic location. To confirm a diagnosis of LF, a laboratory test is required. Here, a reverse transcription loop-mediated isothermal amplification (RT-LAMP) assay using a portable device for the detection of LASV in southeast and south-central Nigeria using three primer sets specific for strains clustered in lineage II was developed. The assay detected in vitro transcribed LASV RNAs within 23 min and was further evaluated for detection in 73 plasma collected from suspected LF patients admitted into two health settings in southern Nigeria. The clinical evaluation using the conventional RT-PCR as the reference test revealed a sensitivity of 50% in general with 100% for samples with a viral titer of 9500 genome equivalent copies (geq)/mL and higher. The detection limit was estimated to be 4214 geq/mL. The assay showed 98% specificity with no cross-reactivity to other viruses which cause similar symptoms. These results suggest that this RT-LAMP assay is a useful molecular diagnostic test for LF during the acute phase, contributing to early patient management, while using a convenient device for field deployment and in resource-poor settings.

Prevalence of malaria in HIV positive and HIV negative pregnant women attending antenatal clinics in south eastern Nigeria.

INTRODUCTION: Globally, malaria in pregnancy is a public health challenge. Malaria and HIV are among the two most important diseases contributing to the global health burden of our time. HIV positive pregnant women are at increased risk of all the adverse outcomes of malaria in pregnancy. OBJECTIVE: The objective of this study was to compare malaria parasitaemia between HIV positive and HIV negative pregnant women attending antenatal clinics offering Preventing Maternal to Child Transmission (PMTCT) services in Enugu metropolis, south-eastern Nigeria. METHODS: A descriptive cross sectional study was conducted among 200 HIV positive and 200 HIV negative pregnant women attending antenatal clinics in Enugu. Two out of five hospitals that provide PMTCT services were selected through balloting. Finger pricked blood samples were collected and thick blood films were examined for malaria parasite using giemsa expert microscopy. A structured interviewer administered questionnaire was used for data collection. Data was analysed using SPSS version 22. RESULTS: The HIV positive pregnant women (152) (76%) and HIV negative women (137) (68.5%) studied were mostly in the age range of 25-34 years. Mean gestational age of HIV positive and HIV negative participants were 23.4±10.7 and 23.2±10.1 weeks respectively (P=0.001). The prevalence of malaria infection among HIV positive pregnant mothers was 81% (162/200) and 75% (150/200) among HIV negative pregnant women (P < 0.001). The HIV positive mothers had more moderate parasitaemia (86/200: 53.1%) compared to 43/200: 28.7% in HIV negative mothers (P<0.001). Even though more HIV positive mothers (54.5%) used insecticide treated nets ITNs during pregnancy compared to 41.5% in HIV negative mothers, moderate malaria parasitaemia was higher in HIV positive mothers. HIV positive nulliparous pregnant women had the highest rate of malaria parasitaemia (32/36: 88.9%). CONCLUSION: Moderate malaria parasitaemia was higher among HIV positive pregnant women. All malaria preventive strategies should be intensified in pregnancy as ITNs provided little protection.

Malaria Knowledge and Treatment Practices in Enugu State, Nigeria: A Qualitative Study.

BACKGROUND: Malaria accounts for 60% of outpatient visits in Nigeria. The aim of the study was to assess the knowledge of malaria and its treatment practices in Enugu state, Nigeria. METHODS: Qualitative data was collected through the use of focus group discussions (FGDs), from six villages three each from urban and rural areas of Enugu state, Nigeria. A total of 18 FGDs involving 189 participants were conducted and data on place of treatment for malaria and drug of choice for malaria treatment were collected. RESULTS: Most discussants had a good knowledge of the signs and symptoms of malaria. They reported late for treatment when they had symptoms suggestive of malaria. Treatment timing was affected by financial capability and perceived severity of disease. There was preference for patent medicine dealers (PMDs) and pharmacies for malaria treatment. The reasons included drug affordability, obtaining preferred drug, short waiting time and polite treatment from the providers. Treatment in most cases was without proper malaria diagnosis. Cost was an important factor in determining the drug of choice for malaria treatment. This could explain why people were not aware of the use of artemisininbased combination therapy while preferring mono-therapies and herbal drugs. Public hospitals were considered as good sources of treatment for malaria although they remain the last resort when treatment from these drug outlets failed. CONCLUSION: The community members preferred PMDs and pharmacies for malaria treatment. Unfortunately, these drug outlets do not encourage the use of artemisinin combination therapy (ACT). This makes it necessary that pharmacists and PMDs are trained on management of malaria. Also, improving the knowledge of the public on the need for malaria diagnosis before treatment and use of artemisinin-based combination therapy will improve the control of malaria. The populace should be instructed to seek treatment early while also discouraging the use of herbal drugs for malaria treatment. There is also the need to improve service delivery at public health facilities.

Patient satisfaction with services at a tertiary hospital in south-east Nigeria.

BACKGROUND: Patients' views of the services they receive in a healthcare service help identify critical areas that may need improvement. This survey set out to determine patients' satisfaction with quality of general services and specifically with staff attitude and the hospital environment, while on admission at a teaching hospital in Enugu, south-east Nigeria. METHODS: This was a descriptive cross-sectional study using a structured self-administered questionnaire on 170 patients (54% females and 46% males, aged between 20 and 65 years), post admission, selected by multistage sampling. RESULTS: Less than half (47.3%) of the patients were satisfied with care received on admission. More than half of them (51.8%) were satisfied with the cleanliness of the hospital environment and how power supply was maintained in the hospital (62.4%). Doctors (90%), nurses (64.1%) and records staff (60.6%) were considered courteous and professional. Most patients were satisfied with the level of privacy given to them in their course of hospital stay (67.6%) and with the cost of laboratory investigations (51.8%). CONCLUSION: Despite more than half of the surveyed patients being satisfied with some specific aspects of services given while on admission, those satisfied with the overall experience were less than half. Therefore, periodic patient satisfaction surveys should be institutionalized in this facility to provide feedback for continuous quality improvement.

Genetic characterization of Lassa virus strains isolated from 2012 to 2016 in southeastern Nigeria.

Lassa virus (LASV) is endemic in parts of West Africa where it causes Lassa fever (LF), a viral hemorrhagic fever with frequent fatal outcomes. The diverse LASV strains are grouped into six major lineages based on the geographical location of the isolated strains. In this study, we have focused on the lineage II strains from southern Nigeria. We determined the viral sequences from positive cases of LF reported at tertiary hospitals in Ebonyi and Enugu between 2012 and 2016. Reverse transcription-polymerase chain reaction (RT-PCR) showed that 29 out of 123 suspected cases were positive for the virus among which 11 viral gene sequences were determined. Phylogenetic analysis of the complete coding sequences of the four viral proteins revealed that lineage II strains are broadly divided into two genetic clades that diverged from a common ancestor 195 years ago. One clade, consisting of strains from Ebonyi and Enugu, was more conserved than the other from Irrua, although the four viral proteins were evolving at similar rates in both clades. These results suggested that the viruses of these clades have been distinctively evolving in geographically separate parts of southern Nigeria. Furthermore, the epidemiological data of the 2014 outbreak highlighted the role of human-to-human transmission in this outbreak, which was supported by phylogenetic analysis showing that 13 of the 16 sequences clustered together. These results provide new insights into the evolution of LASV in southern Nigeria and have important implications for vaccine development, diagnostic assay design, and LF outbreak management.

Standard precaution knowledge and adherence: Do Doctors differ from Medical Laboratory Scientists?

Background: Doctors and laboratory scientists are at risk of infection from blood borne pathogens during routine clinical duties. After over 20 years of standard precautions, health care workers knowledge and compliance is not adequate. Aim: This study is aimed at comparing adherence and knowledge of standard precautions (SP) among Medical Laboratory Scientists (MLSs) and doctors. Methods: It was a cross sectional study done at University of Nigeria Teaching Hospital, ItukuOzalla. A semi structured pre-tested questionnaire was the study instrument. Results: General knowledge of SP was high,76.2% in doctors and 67.6% in MLSs although there were differences between the two groups on the knowledge of components of SP. Safe injection practices, use of personal protective equipment as well as safe handling of contaminated equipment or surfaces was higher amongst doctors. Even though more than half of respondents in both groups, 53.1 % among doctors and 58.1% among MLSs had received training on standard precautions, this did not reflect in the practice. MLS reported more use of personal protective equipment such as gloves and coveralls (100% in MLS and 35% of doctors), P<0.001. Recapping of syringes was higher amongst doctors (63.6%) than MLS (55.1%).The doctors practiced better hand hygiene than MLS (P<0.001). Constraints that affected SP included non-availability of PPEs and emergency situations for both groups. Conclusion: SP knowledge and practice are still low, and as such, there is a need to train doctors and MLS on the components of SP. Policies on SP need to be enforced and facilities for practice regularly supplied.

Households' perceptions and prioritization of tropical endemic diseases in Nigeria: implications for priority setting for resource allocation.

This study was undertaken to explore how rural households perceive and prioritize tropical endemic diseases in different Local Government Areas (LGAs) of Southeast Nigeria. Marked differences in perception and prioritization of endemic diseases exist across the LGAs. Malaria is ranked highest as the most serious disease, followed by typhoid fever and HIV/AIDS. In addition, malaria and other endemic diseases are wrongly perceived as not being serious in some population groups.