Coronavirus Disease 2019 Vaccination Coverage and Seropositivity amongst Nigerians 18 Years Old and Above.

BACKGROUND: This was a cross-sectional community-based survey to study the prevalence of serum antibodies against the severe acute respiratory syndrome coronavirus 1 (SARS-COV-1) and determine possible source of antibodies as to whether from vaccination or from natural infection as well as attempt to compare antibody levels in response to the different four types of vaccines administered in Nigeria. METHODS: A cross-sectional community-based study of the prevalence of serum antibodies against all four vaccine types used in Nigeria amongst a representative sample of people aged 18 years and above in the six geopolitical zones of the country using a multistage sampling technique covering 12 states of the country with two states being randomly selected from each geopolitical zone. High-throughput Roche electrochemiluminescence immunoassay system (Elecsys Anti-SARS-COV-1 Cobas) was used for qualitative and quantitative detection of antibodies to SARS-COV-1 in human plasma. RESULTS: There was no statistically significant difference between the proportions with seropositivity for both the vaccinated and the unvaccinated (P = 0.95). The nucleocapsid antibody (anti-Nc) titres were similar in both the vaccinated and the unvaccinated, whereas the Spike protein antibody (anti-S) titres were significantly higher amongst the vaccinated than amongst the unvaccinated. Antibody levels in subjects who received different vaccines were compared to provide information for policy. CONCLUSION: While only 45.9% of the subjects were reported to have been vaccinated, 98.7% of the subjects had had contact with the SARS-COV-1 as evidenced by the presence of nucleocapsid (NC) antibodies in their plasma. The 1.3% who had not been exposed to the virus, had spike protein antibodies which most likely resulted from vaccination in the absence of NC antibodies. Successive vaccination and booster doses either through heterogeneous or homologous vaccines increased antibody titres, and this stimulation of immune memory may offer greater protection against coronavirus disease 2019.

Challenges with the establishment of congenital cardiac surgery centers in Nigeria: survey of cardiothoracic surgeons and residents.

BACKGROUND: There are gaps in understanding the challenges with the establishment of pediatric cardiac surgical practices in Nigeria. The aim of this study was to examine the prospects and challenges limiting the establishment of pediatric cardiac surgical practices in Nigeria from the perspectives of cardiothoracic surgeons and resident doctors. METHODS: A descriptive study was carried out to articulate the views of the cardiothoracic surgeons and cardiothoracic resident doctors in Nigeria. A self-administered questionnaire was used to generate information from the participants between December 2014 and January 2015. Data were analyzed using the SPSS version 21 statistical software package. RESULT: Thirty-one of the 51 eligible participants (60.7%) took part in the survey. Twenty-one (67.7%) were specialists/consultants, and 10 (32.3%) were resident doctors in cardiothoracic surgical units. Most of the respondents, 26 (83.9%) acknowledged the enormity of pediatric patients with cardiac problems in Nigeria; however, nearly all such children were referred outside Nigeria for treatment. The dearth of pediatric cardiac surgical centers in Nigeria was attributed to weak health system, absence of skilled manpower, funds, and equipment. Although there was a general consensus on the need for the establishment of open pediatric cardiac surgical centers in the country, their set up mechanisms were not explicit. CONCLUSIONS: The obvious necessity and huge potentials for the establishment of pediatric cardiac centers in Nigeria cannot be overemphasized. Nevertheless, weakness of the national health system, including human resources remains a daunting challenge. Therefore, local and international partnerships and collaborations with country leadership are strongly advocated to pioneer this noble service.

Factors influencing the use of malaria prevention methods among women of reproductive age in peri-urban communities of Port harcourt city, Nigeria.

BACKGROUND: Malaria remains a huge national concern in Nigeria with severe implications for maternal and child health. AIMS: This study was aimed at investigating factors that influence malaria prevention among women of reproductive age in line with the National Malaria Control objectives. SUBJECTS AND METHODS: A descriptive, cross-sectional study design and cluster sampling technique was used to recruit study participants. Respondents had 'correct' knowledge of malaria if they knew the cause and symptoms of malaria. Otherwise is classified as 'incorrect'. Data were analysed in Epi Info version 7 with the level of statistical significance set at P 0≤ 0.05. RESULTS: Most respondents, 709 (89%) had good knowledge of malaria. Their educational level was significantly associated with this knowledge (χ2 = 3.6993, P = 0.0544). There were, however, some myths and misconceptions about malaria. Of 390 (49.3%) that owned insecticide treated bed nets (ITNs), only 59 (18.2%) used them consistently, while only 31 (50%) of the pregnant women received intermittent preventive treatment (IPTp). Malaria knowledge, ITNs ownership and female education were not significantly associated with ITN and IPTp usage. Married women had 3 times higher odds of ITN usage than the unmarried, (odds ratio [OR] = 2.69, 95% confidence interval [95% CI] = 1.56-4.62), and women with children had 2 times higher odds of usage than those without (OR = 2.42, 95% CI = 1.42-4.12). CONCLUSIONS: The use of malaria prevention measures among women of reproductive age is still sub-optimal. We advocate for intensified education of women on malaria in local languages, using role plays and community dialogues. Efforts must also be directed at dispelling myths and misconceptions about malaria for maximum impact.

Prevalence and risk factors for stroke in an adult population in a rural community in the Niger Delta, south-south Nigeria.

Sub-Saharan Africa is experiencing an epidemiologic transition with stroke contributing to the disease burden. However, community-based stroke prevalence studies are sparse. This study aimed to determine the prevalence of stroke in a rural population in the Niger Delta region in south-south Nigeria and to describe known risk factors for stroke among them. A door-to-door stroke prevalence study was conducted in 2008 among randomly selected adults of 18 years or older in rural Kegbara-Dere community in Rivers State, south-south Nigeria. We administered a modified screening tool by the World Health Organization, a stroke-specific questionnaire, and conducted a physical/neurological examination (on persons screening positive) in 3 stages of assessments. The crude prevalence of stroke was 8.51/1000 (95% confidence interval [CI] = 3.9-16.1) representing 9 of 1057 participants. The age-adjusted prevalence was 12.3/1000 using the US Population 2000. Men had higher unadjusted prevalence than women (12.9/1000 versus 5.1/1000) but were not at more risk (unadjusted relative risk = .99; 95% CI = .98-1.00). Stroke prevalence increased with age (Mantel-Haenszel χ(2) P = .00). Hypertension (blood pressure ≥140/90 mm Hg) was present in all stroke cases and diabetes mellitus (fasting blood sugar >126 mg/dL) in 1 person, but none had hypercholesterolemia, obesity (body mass index >30 kg/m(2)), or a history of alcohol intake or smoking. Stroke prevalence was found to be high, commoner among men and the elderly population, and likely to be predisposed by hypertension, in rural south-south Nigeria. The need to conduct follow-up studies on the burden and outcomes of stroke among this study population is acknowledged.

Awareness, acceptability, and use of female condoms among university students in Nigeria: implications for STI/HIV prevention.

BACKGROUND: Most university students in Nigeria are sexually active and engage in high risk sexual behaviors. The aim of this study was to assess the acceptability and use of female condoms in the context of HIV prevention in order to provide basic information that can stimulate female condom programming to promote sexually transmitted infection and HIV prevention among youths in tertiary institutions. MATERIALS AND METHODS: A descriptive, cross-sectional study was carried out among 810 undergraduate students of the University of Port Harcourt from October to November 2011, using a stratified sampling method and self-administered questionnaires. RESULTS: Most of the students, 589 (72.7%) were sexually active; 352 (59.7%) reported having just one sexual partner, while 237 (40.3%) had multiple partners. The mean number of sexual partners in the past six months was 2.2 ± 0. Consistent condom use was reported among 388 (79.2%) students, 102 (20.8%) reported occasional usage, while 99 (16.8%) did not use condoms at all. Only 384 (65.2%) of the students had ever been screened for HIV. Although 723 (89.3%) were aware of female condoms, only 64(8.9%) had ever used one due to unavailability, high cost, and difficulty with its insertion. Nevertheless, 389 (53.8%) of the students expressed willingness to use them if offered, while 502 (69.4%) would recommend it to friends/peers. CONCLUSION: This study highlights significant challenges in the use of female condoms among university students. These include unavailability, high cost, and difficulty with insertion. Therefore, deliberate efforts using social marketing strategies, appropriate youth-friendly publicity, and peer education must be exerted to provide affordable female condoms and promote usage; such efforts should target vulnerable youths in Nigerian tertiary institutions.

Sociocultural practices, beliefs, and myths surrounding newborn cord care in Bayelsa State, Nigeria: A qualitative study.

Persisting sociocultural beliefs have continued to significantly influence the adoption of recommended newborn care practices by women in Sub-Saharan Africa. This study aimed at identifying the sociocultural practices, beliefs, and myths surrounding newborn cord care by women residing in Bayelsa State, Nigeria. This was a qualitative study that involved 24 women and 3 traditional birth attendants (TBAs) in three focus group discussions and three in-depth interviews respectively. Interview guides were used to lead the discussions and the interviews which were audiotaped, translated and then transcribed. Thematic analysis was done using NVivo QSR version 12.2 Pro. Several themes describing various sociocultural practices, beliefs, and myths surrounding cord care were uncovered. Most women preferred to be delivered by a TBA who usually cuts the infant's cord with a razor blade and ties the stump with hair or sewing thread. Substances used for cord care included methylated spirirt, "African never-die" leaf, and "Close-Up" toothpaste. All the participants agreed that methylated spirit was a potent antiseptic for cord care but none of them had heard about nor used chlorhexidine gel. It was a common belief that abdominal massage and the application of substances to the cord were solutions to common cord-related problems. Mothers, TBAs and relatives were influential regarding choices of cord care practices. Sociocultural practices, beliefs, and myths are still major barriers to the adoption of recommended cord care practices by women in Bayelsa State. Interventions should be targeted at improving delivery in health facilities and educating women in the community on good cord care practices.

Status of emergency obstetric care in a local government area in south-south Nigeria.

This study assessed the status of the availability and performance of emergency obstetric care (EmOC) in 12 functional public health facilities out of the existing 19 in Gokana Local Government Area of Rivers State in south-south Nigeria, prior to the midwives service scheme (MSS) launch in 2009. No facility qualified as basic EmOC, while one had comprehensive EmOC status. Signal functions that required supply of medical consumables were performed by more facilities than services that required special training, equipment and maintenance. Only two facilities (16.67%) had the minimum requirement of > or =4 midwives for 24-hour EmOC service; while only 2.2% of expected births occurred at the facilities. The poor state of maternal health resources in the study area requires urgent interventions by Local and State Governments for infrastructure upgrade and deployment and training of staff towards attainment of MDG-5. A follow-up evaluation would be required since the commencement of the MSS.

Awareness, perception and the practice of COVID-19 prevention among residents of a state in the South-South region of Nigeria: implications for public health control efforts.

BACKGROUND: As with any epidemic, coronavirus disease 2019 (COVID-19) has evoked panic, fear and misconceptions. The risk communication pillar of the Public Health Emergency Operations Centre is responding to the pandemic by facilitating correct and consistent information to enable the adoption of behaviours to prevent and control COVID-19. This study explored awareness, perception and practice of COVID-19 prevention among residents in Rivers State, Nigeria, during the early stages of the COVID-19 pandemic response. METHODS: This was a descriptive cross-sectional survey among 1294 adult residents across all districts of the state. It employed an interviewer-administered questionnaire. Knowledge was graded as excellent for scores of ≥80%, good for scores of 50-79% and poor for scores of <50%. Respondents who washed all critical parts of their hands were categorised as adopting correct handwashing practice. Regression modelling was employed to determine predictors of knowledge and practice of COVID-19 prevention with p=0.05. RESULTS: The respondents were aged 18-80 y with an average age of 39.6 (SD=11.9) y. A total of 710 (54.9%) were male, 476 (36.8%) were unemployed with 685 (52.9%) having secondary education. The most common sources of information about COVID-19 were radio jingles (1102; 86.7%) and television adverts (940; 74.0%). Overall, 608 (47.0%) of the respondents had a poor knowledge of COVID-19. About 443 (34.9%) respondents believed they were unlikely to contract the virus. Only 505 (39.0%) of respondents washed all the critical parts of their hands correctly. Occupation (adjusted OR [AOR]=1.39, 95% CI 1.07 to 1.82, p=0.01), level of education (AOR=4.71, 95% CI 1.90 to 11.68, p<0.001) and location (AOR=1.75, 95% CI 1.29 to 2.38; p<0.001) significantly predicted respondents' knowledge about COVID-19. The significant predictors of practice of COVID-19 were age (AOR=0.60, 95% CI 0.42 to 0.84, p=0.003), occupation (AOR=1.93, 95% CI 1.41 to 2.63, p<0.001), location (AOR=2.35, 95% CI 1.65 to 3.34, p<0.001) and knowledge about COVID-19 (AOR=7.75, 95% CI 5.94 to 10.11, p<0.001). CONCLUSIONS: Broadcast media has a pivotal role to play in risk communication for behavioural change for the control of current and future epidemics in this population.

Clinical and epidemiological characteristics of 646 hospitalised SARS-Cov-2 positive patients in Rivers State Nigeria: a prospective observational study.

INTRODUCTION: the knowledge of epidemiologic and clinical variables in patients with SARS- CoV-2 infection provides evidence and lessons that are useful for the pandemic response, with consideration of National and sub-National variations. The objective of this study was to characterize and describe the clinical and epidemiologic features of all the hospitalised patients with COVID-19 in Rivers State Nigeria, from March to August 2020. METHODS: a prospective descriptive multi-center study of patients with positive SARS-CoV-2 RT PCR, who were hospitalised for treatment and self-isolation in four treatment centers in Rivers state, Nigeria. RESULTS: the mean age of all the patients was 39.21 ± 12.31 years, with a range of 2 to 77 years. The majority of patients were in the 31 to 40-year (33.0%), 41 to 50-year (23.1%) and 18-to 30-year (22.0%) age groups. The patient population included 474 (73.4%) males and 172 (26.6%) females, with 93 (14.4%) healthcare workers. A history of contact and travel was established in 38.5% and at least one comorbid disease condition was present in 32.8% of patients. Patients with severe disease were 61 (9.45%), while the overall case fatality rate was 2%. The leading comorbid disease conditions were Hypertension in 23.8% and diabetes in 7.7% of patients. Fever (26.0%), dry Cough (17.6%), dyspnoea (12.7%), anosmia (12.7%) and headache (9.9%) were the most common symptoms. The presence of comorbidity and increasing age predicted death from COVID-19. CONCLUSION: the clinical and epidemiologic characteristics of this cohort of hospitalised patients show significant similarities with existing trends from previously reported studies, with contextual peculiarities.

Is living in a gas-flaring host community associated with being hypertensive? Evidence from the Niger Delta region of Nigeria.

BACKGROUND: Researchers have linked gas flaring to climate change, the hastening of the epidemiological transition and an upsurge in the prevalence of non-communicable diseases. We sought to determine if a relationship exists between residing in a gas-flaring host community and hypertension. METHODS: We conducted an analytical cross-sectional household survey among residents of 600 households in three gas-flaring and three non-gas-flaring host communities in the Niger Delta region of Nigeria. We took geo-coordinates, administered a modified WHO-STEPS questionnaire and built on Android mobile phones using Open-Data-Kit (ODK) software. We also took biological measurements and carried out descriptive and inferential statistical analysis using SPSS and STATA. RESULTS: We interviewed a total of 912 adults: 437 (47.9%) from non-gas-flaring and 475 (52.1%) from gas-flaring host communities. There were differences in level of education (x2=42.99; p=0.00), occupation category (x2=25.42; p=0.00) and BMI category (x2=15.37; 0.003) among the two groups. The overall prevalence of hypertension was 23.7%: 20.7% among persons living in non-gas-flaring host communities compared with 25.3% among persons living in gas-flaring host communities (x2=2.89; p=0.89). Residence in a gas-flaring host community, (AdjOR=1.75; 95% CI=1.11 to 2.74) and mean age (AdjOR=1.05; 95% CI=1.03 to 1.07) were identified as the predictors of hypertension. There was a significant association between hypertension and age, 1.05 (1.04-1.06) while the probability of being hypertensive was higher among residents of gas-flaring host communities between 20 to 40 years and 60 to 80 years. CONCLUSION: There is a need for the relevant agencies to scale up environmental and biological monitoring of air pollutants. The implication of a possible relationship between gas-flaring and hypertension brings to the fore the need for interventions to regulate gas-flaring activities.

Quality and rural-urban comparison of tuberculosis care in Rivers State, Nigeria.

INTRODUCTION: Nigeria ranks among countries with the highest burden of tuberculosis. Yet evidence continues to indicate poor treatment outcomes which have been attributed to poor quality of care. This study aims to identify some of the systemic problems in order to inform policy decisions for improved quality of services and treatment outcomes in Nigeria. METHODS: A comparative assessment of the quality of TB care in rural and urban health facilities was carried out between May and June 2013, employing the Donabedian model of quality assessment. Data was analysed using the SPSS software package version 20.0. The level of significance was set at p < 0.05. RESULTS: Health facility infrastructures were more constrained in the urban than rural settings. Both the urban and rural facilities lacked adequate facilities for infection control such as, running water, air filter respirators, hand gloves and extractor fans. Health education and HIV counselling and testing (HCT) were limited in rural facilities compared to urban facilities. Although anti-TB drugs were generally available in both settings, the DOTS strategy in patient care was completely ignored. Finally, laboratory support for diagnosis and patient monitoring was limited in the rural facilities. CONCLUSION: The study highlights suboptimal quality of TB care in Rivers State with limitations in health education and HCT of patients for HIV as well as laboratory support for TB care in rural health facilities. We, therefore, recommend that adequate infection control measures, strict observance of the DOTS strategy and sufficient laboratory support be provided to TB clinics in the State.

Human immunodeficiency virus screening in rural communities of Rivers State, Nigeria: challenges and potential solutions.

BACKGROUND: Human immunodeficiency virus (HIV) testing and counseling has remained significantly low in rural communities of Nigeria despite the huge benefits of early case detection and treatment. This study aims at evolving strategies based on the health-seeking attitudes of rural people in order to improve their HIV testing access. MATERIALS AND METHODS: A cross-sectional study was carried out between May and June 2011 among persons of reproductive ages, that is, 15 years and above for men and 15-49 years for women; normally resident in rural communities of Rivers State, Nigeria, selected using a multistage sampling technique. RESULTS: A total of 267 (42.0%) males and 368 (57.9%) females were interviewed. Most of the respondents (619, 97.5%) had heard about HIV, and 498 (78.4%) were aware of its transmission by sexual route. Condom use was low and non-use with a nonmarital partner 12 months preceding the survey was 33.8% (191). Only 242 (38.1%) had ever tested for HIV: 90 (37.2%) men and 152 (62.8%) women (χ2 = 15.14, degree of freedom (df) =1, P = 0.000), while only 33 (13.6%) had tested for HIV based on sexual risk perceptions. The commonest reasons for HIV testing were pregnancy, premarriages, and test for concordance. Reasons for not testing were lack of perception of HIV risk, fear of stigmatization, and discrimination from positive test result. CONCLUSION: This study highlights the persistence of low HIV testing culture in rural settings in Nigeria and underscores the need that HIV programs should look beyond the healthcare settings and involve the communities, using home and community-based testing approaches in order to expand HIV testing access.

Utilization of intermittent preventive treatment of malaria by pregnant women in rivers state, Nigeria.

BACKGROUND: This study was conducted to assess the level of intermittent preventive treatment of malaria in pregnancy (IPTp) in Rivers State, Nigeria, to identify obstacles prohibiting utilization in order to make recommendations for improved uptake and malaria control in general. METHODS: A cross-sectional study was carried out in November 2008 among 339 pregnant women and those who had delivered children in the last 1 year, using a multistage sampling method. Data were analyzed using the Epi-Info version 6.04d statistical software package and hypothesis tests were conducted to compare summary statistics at 95% significance level. RESULTS: Most of the respondents (76.4%) had knowledge that malaria was caused by mosquitoes and was harmful in pregnancy. Although majority of the pregnant women (80.8%) attended antenatal care clinics, knowledge of the correct use of SP was low (32.6%) and only 62.8% took malaria preventive treatment. Of these, 58.4% took SP, while nearly a third, 31.8%, took chloroquine. Only 16.4% took their SP at the health facility directly observed by health workers according to the national guidelines. The commonest reason for not preventing malaria was that they were not sick during the period of pregnancy. CONCLUSIONS: Misconceptions about IPTp persist among women known to have attended antenatal care clinics, resulting in only a minority of pregnant women receiving IPTp as recommended by national guidelines. Efforts directed at awareness creation on the new malaria prevention and treatment policy are therefore necessary to enhance the uptake of IPT in pregnancy in Rivers State. Further studies are however, needed to evaluate the knowledge and practices of health care workers on the new malaria treatment policy.