Challenges in conducting population-based seroepidemiology survey of COVID-19 in Lagos State, Nigeria.

Population-based study is known to be a very essential type of study during and after a pandemic or epidemic, as it provides crucial information on the incidence, prevalence, and risk factors of the disease in question. There has been limited information about the challenges faced in conducting such surveys in Nigeria. In this paper, we will share our experience, and describe the challenges faced in conducting a population-based seroepidemiological study of COVID-19 in Lagos, Nigeria. Some challenges were peculiar to specific Local Government Areas (LGAs) while others were general. The challenges include general misconceptions of community members about health research, difficulties in mapping houses, planning for data collection, standardizing data collection, working in hard-to-reach communities when resources were limited as well as difficulty in collection of blood and naso-oropharyngeal swabs. Ways of overcoming these problems, lessons learnt, and recommendations are hereby discussed.

Anthrax toxins-producing Bacillus spp. isolated from handwashing stations during COVID-19 pandemic in Lagos, Nigeria.

INTRODUCTION: The virulence binding factor, protective antigen (pag) and poly-D-γ-glutamate capsular (cap) genes, peculiar to Bacillus anthracis are located in the pXO1 and pXO2 plasmids which are transferable horizontally to related species called "cereus group". The cereus group are usually isolated from the environmental/food samples and have been implicated in debilitating human and animal anthrax-like diseases. This study was designed to investigate the presence of the anthrax virulence genes in different Bacillus spp. isolated from handwashing facilities during COVID-19 pandemic in Lagos, Nigeria. METHODOLOGY: The Bacillus anthracis (OK316847), B. thuringiensis (OK316855), B. amyloliquefaciens (OK316857), B. cereus (OK316858) and B. thuringiensis (OK316859) previously isolated from rinsates and bowl water in two local government areas (LGAs) of Lagos state were further investigated by the polymerase chain reaction (PCR) amplification of the pag and cap genes using specific primers. RESULTS: Bacillus anthracis and B. cereus co-harboured the two 578 bp cap and 364 bp pag genes while B. thuringiensis only harboured the cap gene. Similarly, the non-cereus B. amyloliquefaciens was found to habour the pag gene. CONCLUSIONS: The two anthrax toxin genes were amplified in the Bacillus spp isolated from rinsates and bowl water used in hand washing in the two study LGAs. Given that these virulence genes have a global consequence and are a potential threat to life, this study calls for an extensive surveillance, and reassessment of gene regulators and plasmid distribution among these strains in our environment.

Screening, isolation and biotechnological potentials of foodborne Lactobacillus fermentum strains MT903311 and MT903312.

Vitamins are an essential food source with excellent roles in the cellular metabolism and other essential nutrients required in food intake but cannot be synthesized by humans. There have been reports of some lactic acid bacteria (LAB) abilities with probiotic activities to produce food-grade vitamins. Our study aimed to investigate lactic acid bacteria (LAB) possessing antimicrobial activities and extracellular production of folate from different Nigerian fermented foods. LAB was assayed for their antimicrobial activities against clinical isolates of Escherichia coli and Salmonella typhimurium and their extracellular production of essential vitamins. Among the 43 isolates of LAB, two strains of Lactobacillus fermentum showed the highest inhibitions against the test bacteria and demonstrated the highest concentrations of extracellular vitamins production. The range of vitamins produced at 24 h was between 12.23 and 801.79 µg/ml, while the highest vitamin production of 801.79 and 310.55 µg/ml was observed for folate and vitamin B12 respectively, the lowest production was for B1+B2. Consistent vitamin production was typical with only L. fermentum MT903311 and L. fermentum MT903312, so were their antimicrobial activities. The L. fermentum strains isolated in this study could be exploited and applied in food products to substitute synthetic vitamin enrichment and fortification.

A designathon to co-create community-driven HIV self-testing services for Nigerian youth: findings from a participatory event.

BACKGROUND: Youth are at high risk for HIV, but are often left out of designing interventions, including those focused on adolescents. We organized a designathon for Nigerian youth to develop HIV self-testing (HIVST) strategies for potential implementation in their local communities. A designathon is a problem-focused event where participants work together over a short period to create and present solutions to a judging panel. METHODS: We organized a 72-h designathon for youth (14-24 years old) in Nigeria to design strategies to increase youth HIVST uptake. Proposals included details about HIVST kit service delivery, method of distribution, promotional strategy, and youth audience. Teams pitched their proposals to a diverse seven-member judging panel who scored proposals based on desirability, feasibility, potential impact and teamwork. We examined participants' socio-demographic characteristics and summarized themes from their HIVST proposals. RESULTS: Forty-two youth on 13 teams participated in the designathon. The median team size was 3 participants (IQR: 2-4). The median age was 22.5 years (IQR: 21-24), 66.7% were male, 47.4% completed tertiary education, and 50% lived in Lagos State. Themes from proposals included HIVST integration with other health services, digital marketing and distribution approaches, and engaging students. Judges identified seven teams with exceptional HIVST proposals and five teams were supported for further training. CONCLUSIONS: The designathon provided a structured method for incorporating youth ideas into HIV service delivery. This approach could differentiate HIV services to be more youth-friendly in Nigeria and other settings.

Incidence of Multidrug-Resistant Escherichia coli Harbouring blaTEM and tetA Genes Isolated from Seafoods in Lagos Nigeria.

The presence of multidrug-resistant Escherichia coli of fecal origin in seafood is a serious concern. Seafood containing MDR E. coli can serve as a medium for the transfer of resistant bacteria to consumers. The aim of the present study is to isolate and identify multidrug-resistant E. coli and associated resistant genes from selected seafood (catfish, crabs and tilapia fish) purchased from wholesalers and retailers at sea landing areas in Lagos state, Nigeria. A total of two hundred and thirty-eight (238) samples consisting of catfish (52), tilapia fish (78) and crab (108) were collected and investigated for the presence of E. coli from the period of June 2018-April 2019. Colonies that showed metallic sheen were considered presumptive E. coli isolates, and positive isolates were chosen for further confirmed by biochemical methods using IMViC tests, Oxidase test, triple sugar iron agar test and sugar fermentation test. Antimicrobial susceptibility of the isolates to eight classes of antibiotics was determined by disc diffusion methods while amplification of suspected antibiotic resistance genes were done by the polymerase chain reaction (PCR) using specific primers. A total of 105 (44.1%) E. coli were isolated from selected samples by standard microbiological procedures. The grand total of 59 (56.2%) isolates showed multiple antibiotic-resistant patterns. The overall result showed high-level resistance to tetracycline 101/105 (96.1%) and trimethoprim 90/105 (85.7%), cefotaxime 67/105 (42.9%) while the highest susceptibility of 101/105 (96.2%) was recorded for amikacin followed by gentamicin 84/105 (80%), meropenem 75/105 (71.4%), ceftazidime (69.5). The presence of tetA and blaTEM was prevalent among the isolates. Our results indicate that seafood may be a reservoir of ß-lactam and tetracycline-resistance determinants.

Self-reported use of and access to personal protective equipment among healthcare workers during the COVID-19 outbreak in Nigeria.

The SARS-CoV-2 virus is highly infectious resulting in increased infection and death among the front-line Healthcare Workers (HCW) because of limited access to personal protective equipment (PPE). This study assesses the availability and self-reported use of PPE amongst HCW during the COVID-19 pandemic in Nigeria. A mixed-method study was conducted through a cross-sectional survey and in-depth interviews amongst HCW. Quantitative data analysis was done using SPSS version 26 and thematic analysis was done for the in-depth interview. A total of 258 HCW completed the survey while 15 HCW took part in the in-depth interview. The mean age was 40 (±8.6) years, 67.4% were female and 83.3% were married. 49% were Doctors, 21.1% were Nurses, 28.7% were other allied HCW and 62.2% had at least 10 years of practice experience. Only 22.1% of HCWs had regular access to PPE and only 20.6% had access to N-95 facemask compare to other PPEs. Male HCWs and those working at secondary or tertiary facilities had access to N-95 facemask (p-value 0.025 and 0.010 respectively). The facilitator of PPE use is leadership quality of hospital head and donation of PPE to the facilities while the barriers to PPE use include a limited supply of PPE, as well as facility's infrastructural and operational challenges. The study reported limited access to essential PPE with varying perspectives on its use. Therefore, access, knowledge, and appropriate use of PPE need urgent attention with improved implementation of infection control policy at the facility level.

Designing HIV Testing and Self-Testing Services for Young People in Nigeria: A Discrete Choice Experiment.

BACKGROUND AND OBJECTIVE: A third of new human immunodeficiency virus (HIV) infections occur among young people and the majority of young people living with HIV are in sub-Saharan Africa. We examined the strength of Nigerian youth preferences related to HIV testing and HIV self-testing (HIVST). METHODS: Discrete choice experiments were conducted among Nigerian youth (age 14-24 years). Participants completed one of two discrete choice experiments: (1) preferred qualities of HIV testing (cost, location of test, type of test, person who conducts the test, and availability of HIV medicine at the testing site) and (2) preferred qualities of HIVST kits (cost, test quality, type of test, extra items, and support if tested positive). A random parameter logit model measured the strength of preferences. RESULTS: A total of 504 youth participated: mean age 21 years (standard deviation 2 years), 38% male, and 35% had a higher than secondary school education. There was a strong preference overall to test given the scenarios presented, although male individuals were less likely to test for HIV or use HIVST kits. Youth preferred HIV testing services (with attributes in order of importance) that are free, blood-based testing, available in private/public hospitals or home, for HIV medications to be available in the same location as testing, and a doctor conducts the test. Participants preferred HIVST kits (with attributes in order of importance) that are available from community health centers, free, approved by the World Health Organization, include other sexually transmitted infection testing, have the option of an online chat, and oral-based HIVST. CONCLUSIONS: The HIV home testing was equally preferred to testing in a hospital, suggesting a viable market for HIVST if kits account for youth preferences. Male youth were less likely to choose to test for HIV or use HIVST kits, underscoring the need for further efforts to encourage HIV testing among young male individuals.

Mucoadhesive Microspheres of Maraviroc and Tenofovir Designed for Pre-Exposure Prophylaxis of HIV-1: An in vitro Assessment of the Effect on Vaginal Lactic Acid Bacteria Microflora.

PURPOSE: To formulate and evaluate microspheres of the antiretroviral drugs maraviroc and tenofovir intended for a candidate vaginal microbicide and assess its effect on the vaginal lactic acid bacteria microflora. METHODS: Ionic gelation technique was used to formulate maraviroc and tenofovir microspheres with subsequent characterization. The effect of varying concentrations of the polymer, crosslinking agent and the curing time on the outcome variables viz: particle size, mucoadhesion and encapsulation efficiency were investigated. Lactic acid bacteria were isolated from the vagina of healthy women using standard microbiologic methods. The analysis of their 16S rRNA sequence data identified Lactobacillus fermentum and Enterococcus faecalis strains which were assigned GenBank accession numbers. The efficacy of the microspheres on HIV-1BaL strain was evaluated using TZM-bl indicator cells. RESULTS: The optimal maraviroc and tenofovir microspheres had particle sizes of (434.82 µm and 456.18 µm), mucoadhesion of (93.3% and 90%) and encapsulation efficiency (92.80% and 78.9%) respectively. Maraviroc release kinetics followed a zero-order model and tenofovir was released via Higuchi model. The assay of a 1 mg/mL suspension of the microspheres on the strains of Lactobacillus fermentum and Enterococcus faecalis showed a viability of 93.9% and 89.7%, respectively. There was a statistically significant difference between the mean absorbance readings of the test agent and that of the positive control (P = 0.001). The microspheres elicited a progressive decline in HIV infectivity until at a concentration of 1 µg/mL. CONCLUSION: The antiretroviral drugs loaded in the microspheres, had good mucoadhesion which is a potential for prolonged residence time in the vagina. The antiretroviral drugs were adequately released from the microspheres and showed efficacy against the HIV-1 BaL virus strain. There was no significant disruption in the growth of the lactic acid bacteria which constitute valuable bacteria microflora of the vagina.

Strategies for enhancing uptake of HIV self-testing among Nigerian youths: a descriptive analysis of the 4YouthByYouth crowdsourcing contest.

Introduction: Youth are often the intended beneficiaries of HIV programs but are rarely involved in program design. Engaging youth in program design is one potential way of identifying promising approaches for HIV service delivery. The purpose of this study is to examine the feasibility of using a crowdsourcing contest to solicit ideas on ways to promote HIV self-testing (HIVST) services among Nigerian youths. Methods: From October-November, 2018 Nigerian youth 10-24 years old submitted ideas to a crowdsourcing contest on how to promote HIVST among their peers. Submissions were scored on feasibility, desirability, and impact, with an integer score of 1 (low) to 3 (high) in each domain. The three-domain scores were added to calculate a total score (3-9). The demographic characteristics of contestants were calculated using descriptive statistics. Results: Nine-hundred and three entries were received, 831 had unique valid responses, and 769 were eligible for scoring. Youth submitted ideas on paper (44.9%), Google Forms (39.4%), WhatsApp (9.6%), and email (6.1%). Participants' ages were 10-14 years (37%), 15-19 years (44%), and 20-24 years (22%).Approximately half were female (51.2%). Mean scores were 1.4/3.0 (SD=0.6) for feasibility, 1.4/3.0 (SD=0.6) for desirability, 1.2/3.0 (SD=0.5) for impact, and 4.0/9.0 (SD=1.5) overall. Eight percent of submissions had an overall score >7. A disproportionate share of these high-quality submissions came from email and Google submissions. Conclusion: The 4 Youth by Youth crowdsourcing contest engaged a broad audience and is a feasible way to elicit potential strategies to distribute HIVST kits to other youth. Several high-quality ideas require further evaluation.

Implementation of a modified drive-through sampling strategy for SARS-CoV-2-the Nigerian experience.

INTRODUCTION: effective and safe means of sample collection is a crucial component of testing for Covid-19. Uptake of testing is key to containing and controlling the spread of the virus. Scientists have been working on various strategies that will increase the uptake of testing for COVID-19. One such method involves the use of the drive-through sampling strategy. METHODS: data was collected by both qualitative and quantitative methods. An eligibility form was filled online. While in-depth interviews were conducted for the qualitative aspect of the study. RESULTS: 2,600 visits were recorded at the website, 2300 (88.46%) participants successfully registered for the test. 57.4% were found eligible of which 78.0% presented for the test. This Consisted of 78.0% drive-through and 22.0% walk-in. The average time for transiting through the drive-through site was 19.2 ± 4.6minutes while that of the walk-in was 28 ± 9.2min. This difference was statistically significant (p<0.001). In the qualitative component, respondents opined that maximum safety measures were deployed to protect both participants and health workers. Most said that the turnaround time for the sampling process was short. CONCLUSION: the sampling strategy although largely successful, is largely dependent on Internet penetrability, thus this sampling modality will be best utilized as an adjunct to established models of sample collection.

Molecular characterization of the circulating strains of Vibrio cholerae during 2010 cholera outbreak in Nigeria.

This study aimed at characterizing the phenotypic and toxigenic status of circulating strains of cholera during outbreaks in Nigeria, employing molecular typing techniques. Two hundred and one samples of rectal swabs, stool, vomitus, water (from the well, borehole, sachet, stream, and tap) and disinfectants (sodium hypochlorite) were collected from three states in the country. The samples were inoculated on thiosulphate-citrate bile salt-sucrose (TCBS), Cary-Blair transport medium and smeared on glass slides for direct examination. The Vibrio cholerae isolates were serotyped, biotyped, and characterized using PCR of the cytotoxin gene A (ctxA), wbeO1, and wbfO139 gene primer. Of the 201 samples screened, 96 were positive for V cholerae O1 (48%), with 69 (72%) positive for ctxA gene. The results from this study showed that the circulating strains of cholera in Nigeria were of Ogawa serotype, also observed in other outbreaks in Nigeria (1991, 1992, and 1996). However, the strains were of the Classical biotype and were mainly (72%) ctxA gene-positive. This current investigation has confirmed the production of cholera toxin by the circulating strains, and this could be harnessed for possible cholera vaccine production in Nigeria.

An assessment of the emergency response among health workers involved in the 2010 cholera outbreak in northern Nigeria.

BACKGROUND: The 2010 cholera outbreak in northern Nigeria affected over 40,000 people, with a case fatality rate (CFR) of ≥3.75%. We assessed the emergency response of health care workers (HCWs) involved in case management. METHOD: This was a cross-sectional study with data collected through a self-administered questionnaire. Data entry and analysis were performed using Epi info software. RESULTS: A total of 56 HCWs were interviewed. The mean age was 31 years (SD±8.16 years). The majority of the HCWs (80%; n=45) were aged 18-39 years. Most were community health extension workers (60%), and 3.6% (n=2) were medical doctors. Many of the HCWs had less than 2 years of work experience (42%). Additionally, 82% of the respondents had <1 week of cholera emergency response training, and 50% of the HCWs managed >20 suspected cases of cholera per day. Although 78% of HCWs reported the practice of universal safety precautions, 32% (n=18) knew HCWs who developed symptoms of cholera during the epidemic, most of which was believed to be hospital acquired (78%). We also found that 77% (n=43) of HCWs had no access to the required emergency response supplies. CONCLUSION: Inadequate training, a lack of qualified HCWs and a limited supply of emergency response kits were reported. Therefore, the government and stakeholders should address the gaps noted to adequately control and prevent future epidemics.

Chlamydia and Vaginitis in Sexually Active Females: Classical Identification Methods for Effective Control

Laboratory diagnosis of Chlamydia and vaginitis in sexually active females has been limited by unavailability of a sequential method/rapid technique for simple diagnosis. Six hundred (600) adult females from hotel/brothel; Sexually Transmitted Infections (STIs) Clinic; Obstetrics/Gynaecology Clinic; Family Planning Clinic and Healthy controls were investigated for Chlamydia; Candida; trichomoniasis and bacterial vaginosis (BV). This was done using microscopy: wet mount; stained vaginal secretion and stained smear after culture. Results showed that there were 72infections in the female groups. The brothel and STI group had infection in the range (70-86). Chlamydial infection was highest in the STI group while Candida infection was highest in the healthy (control) females. Bacterial vaginosis was distributed in all groups. As p-value increased; f-value increased indicating constant co-infection of Candida and BV in Chlamydia positive females. Microscopy by direct detection from sample and stained smear after culture were in the range: 56-86. Direct microscopy for BV was 78.5and stained smear after culture; 57.1. Sensitivity and specificity of the techniques showed that detection of Chlamydia was less sensitive by direct microscopy of sample but sensitivity and specificity of stained smear after culture were high. Immunoassay (32.2) was also less sensitive. Sensitivity and specificity of wet mount microscopy for Candida; Trichomoniasis and BV were in the range 62.5 - 80and 62.5-97.8respectively. Wet mount has high sensitivity and specificity for detecting agents of vaginitis and may be useful for routine use and for diagnosis where disease is absent; thus; making identification more cost effective