Instituting coronavirus disease 2019 testing: opportunities and challenges of molecular laboratory diagnosis in a Southern Nigerian teaching hospital.

The coronavirus disease 2019 pandemic emphasised the importance of laboratory preparedness, including molecular diagnostic capacity, in the control of infectious disease outbreaks. This article reflects on diagnostic capacity-building opportunities presented by the pandemic, the challenges experienced along the way and the lessons learned from the perspective of a university teaching hospital in Southern Nigeria. We advocate for these lessons to inform strategic planning for laboratory preparedness at subnational, national and continental levels.

Improving cancer incidence evaluation through local government area matching: a study of the Edo-Benin cancer registry in Nigeria.

BACKGROUND: Cancer registries in Nigeria, as well as in other sub-Saharan African countries, face challenges in adhering to international cancer registration standards. We aimed to improve cancer incidence estimation by identifying under-reporting of new cancers through matching patient-reported local government areas (LGAs) in Edo state, Nigeria, to their respective catchment populations. METHODS: Information on cancers was obtained from records of hospitals, medical clinics, pathology laboratories, and death certificates according to IARC guidelines. We utilized normalized scores to establish consistency in the number of cancers by calendar time, and standardized incidence ratios (SIR) to assess the variation in cancer incidence across LGAs compared to Edo state average. Subsequently, we estimated sex- and site-specific annual incidence using the average number of cancers from 2016 to 2018 and the predicted mid-year population in three LGAs. Age-standardization was performed using the direct method with the World Standard Population of 1966. RESULTS: The number of incident cancers consistent between 2016-2018 in Egor, Oredo, and Uhunmwonde showed a significantly increased SIR. From 2016 to 2018 in these three LGAs, 1,045 new cancers were reported, with 453 (42.4%) in males and 592 (57.6%) in females. The average annual age-standardized incidence rate (ASR) was 50.6 (95% CI: 45.2 - 56.6) per 105. In men, the highest incidence was prostate cancer (ASR: 22.4 per 105), and in women, it was breast cancer (ASR: 16.5 per 105), and cervical cancer (ASR: 12.0 per 105). Microscopically verified cancers accounted for 98.1%. CONCLUSIONS: We found lower age-standardized incidence rates than those reported earlier for the Edo state population. Collecting information on the local government areas of the cancers allows better matching with the respective target population. We recommend using LGA information to improve the evaluation of population-based cancer incidence in sub-Saharan countries.

Correction: Implementation of a COVID-19 screening tool in a southern Nigerian tertiary health facility.

[This corrects the article DOI: 10.1371/journal.pgph.0000578.].

Implementation of a COVID-19 screening tool in a southern Nigerian tertiary health facility.

Screening for coronavirus disease 2019 (COVID-19) in emergency rooms of health facilities during outbreaks prevents nosocomial transmission. However, effective tools adapted for use in African countries are lacking. This study appraised an indigenous screening and triage tool for COVID-19 deployed at the medical emergency room of a Nigerian tertiary facility and determined the predictors of a positive molecular diagnostic test for COVID-19. A cross-sectional study of all patients seen between May and July 2020 at the Accident and Emergency of the University of Benin Teaching Hospital was conducted. Patients with any one of the inputs- presence of COVID-19 symptoms, history of international travel, age 60 years and above, presence of comorbidities and oxygen saturation < 94%- were stratified as high-risk and subjected to molecular testing for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Data was obtained from the screening record book patterned after a modified screening tool for COVID-19, deidentified and entered into IBM-SPSS version 25.0. Binary logistic regression was conducted to determine significant predictors of a positive SARS-CoV-2 test. The level of significance was set at p < 0.05. In total, 1,624 patients were screened. Mean age (standard deviation) was 53.9±18.0 years and 651 (40.1%) were 60 years and above. One or more symptoms of COVID-19 were present in 586 (36.1%) patients. Overall, 1,116 (68.7%) patients were designated high risk and tested for SARS-CoV-2, of which 359 (32.2%) were positive. Additional inputs, besides symptoms, increased COVID-19 detection by 108%. Predictors of a positive test were elderly age [AOR = 1.545 (1.127-2.116)], co-morbidity [AOR = 1.811 (1.296-2.530)] and oxygen saturation [AOR = 3.427 (2.595-4.528)]. This protocol using additional inputs such as oxygen saturation improved upon symptoms-based screening for COVID-19. Models incorporating identified predictors will be invaluable in resource limited settings.

Setting up a molecular diagnostic laboratory for SARS-CoV-2 testing: Experience of a single centre in a resource-constrained setting.

BACKGROUND: Molecular detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is at the forefront of the global response to the coronavirus disease 2019 (COVID-19) pandemic. However, molecular diagnostic capabilities are poorly developed in many African countries. Efforts by the Nigeria Centre for Disease Control and other public health agencies to scale up facilities for molecular testing across the continent are well documented, but there are few accounts from the laboratories at the frontline. INTERVENTION: As part of an institutional response to the COVID-19 pandemic, the University of Benin Teaching Hospital, Benin City, Nigeria, signed a memorandum of understanding with a World Bank-supported institution to obtain a non-proprietary testing platform, renovated an existing molecular virology laboratory and validated the test process to make SARS-CoV-2 testing readily available for decision-making by frontline health workers. These efforts resulted in the University of Benin Teaching Hospital's inclusion in the Nigeria Centre for Disease Control COVID-19 molecular laboratory network. The laboratory achieved a turnover of 12 123 tests within 7 months of operation. Challenges faced and dealt with include incompatible equipment, limited skilled manpower, unstable (unreliable) electric power supply, disrupted procurement and supply chain, and significant overhead costs. LESSONS LEARNT: Molecular diagnostic capability is essential in laboratory preparedness for pandemic response and can be achieved by establishing collaborative networks in low-resource settings. RECOMMENDATIONS: Molecular diagnostic capabilities attained during the COVID-19 pandemic should be maintained by governmental support of the local biotechnology sector, collaboration with partners and stakeholders and the expansion of diagnostics to include other diseases of public health importance.

Preparedness and response of a tertiary hospital to the COVID-19 pandemic in Nigeria: challenges, opportunities and lessons.

Africa was the last continent to be affected by the COVID-19 pandemic. Much of the discourse on Africa's response captured in scientific journals revolves around nations, public health agencies and organizations, but little is documented about how individual healthcare facilities have fared. This article reports the challenges faced in a tertiary hospital in Nigeria, including space constraints, diagnostic challenges, shortages in personal protective equipment and health worker infections. The opportunities and strengths that aided the response are also highlighted. The lessons learned will be useful to similar facilities. More information about health facility response at various levels is needed to comprehensively assess Africa's response to the pandemic.

Facility-Based Surveillance Activities for COVID-19 Infection and Outcomes among Healthcare Workers in a Nigerian Tertiary Hospital.

COVID-19 in healthcare workers (HCWs) can result in nosocomial transmission, depletion in available workforce, and enhanced community transmission. This article describes surveillance for COVID-19 in HCWs at a tertiary healthcare facility, and documents the outcomes. A descriptive cross-sectional study of all HCWs identified from surveillance for COVID-19 from March 31 to August 31, 2020 was conducted. Healthcare workers were categorized as high risk and low risk using an adapted WHO Risk Assessment tool. Nasopharyngeal and oropharyngeal swab specimens obtained from high-risk subjects were tested by a reverse transcriptase PCR method. Data were analyzed with IBM SPSS version 25.0 software (IBM SPSS Statistics for Windows, Version 25.0, Armonk, NY), and results were presented as frequencies and percentages. The level of significance was set at P < 0.05. During 5 months of surveillance, 1,466 HCWs with a mean age of 38.1 ± 9.7 years were identified as contacts. On risk assessment, 328 (22.4%) were adjudged high risk. High risk was associated with increasing age (P < 0.001), male gender (P = 0.001), and nonclinical staff (P = 0.002). Following testing, 78 (5.3%) in the high-risk category were confirmed to have COVID-19. There was no record of COVID-19 in HCWs adjudged low risk. Forty-four (56.4%) cases were epidemiologically linked to the community, 20 (25.7%) to patients, and 14 (17.9%) to another HCW. Surveillance and risk assessment are crucial to COVID-19 response in healthcare facilities and revealed HCW infections with predominantly nonoccupational epidemiological links in this study.

Cardiac rhabdomyoma in a neonate with supraventricular tachycardia.

Cardiac rhabdomyoma (CR) is a rare tumor commonly associated with tuberous sclerosis. They are often detected prenatally or in early infancy. The case of a Nigerian human immunodeficiency virus (HIV)-exposed neonate with CR who presented with supraventricular tachycardia and cardiovascular collapse is presented. The infant was born to a mother on highly active antiretroviral therapy (HAART). The possible role of HIV and HAART in CR etiology and the difficulty in the management of this case are highlighted.