Effectiveness of online training in improving primary care doctors' competency in brief tobacco interventions: A cluster-randomized controlled trial of WHO modules in Delta State, Nigeria.

BACKGROUND: The World Health Organization (WHO) strongly recommends that brief tobacco interventions should be routinely offered in primary care. However, medical doctors do not consistently and effectively intervene during their encounters with cigarette smokers. There is a paucity of studies assessing the effect of training on the tobacco intervention competency of primary care doctors in Nigeria. AIM: To evaluate the effectiveness of online training in improving competency in brief tobacco interventions among primary care doctors in Delta State, Nigeria. METHODS: A cluster-randomized controlled trial was conducted among eligible doctors working in government-owned facilities. The 22 eligible Local Government Areas (LGAs) served as clusters. The intervention group received a WHO six-hour online course on brief tobacco cessation intervention, delivered via Zoom. The control group received no intervention. A structured questionnaire was sent to participants via WhatsApp before and six months after the training. The primary outcome variables were scores for knowledge, attitude, self-efficacy, and practice. Differences in change of scores between intervention and control groups were assessed with t-test. To adjust for clustering, these inter-group differences were further analyzed using linear mixed-effects regression modeling with study condition modeled as a fixed effect, and LGA of practice entered as a random effect. RESULTS: The intervention group had a significantly higher mean of change in scores for knowledge (effect size 0.344) and confidence (effect size 0.52). CONCLUSION: The study shows that training, even online, positively affects clinician competency in brief tobacco intervention. This is important for primary care systems in developing countries. Mandatory in-service training and promotion of the WHO modules are recommended.

Effect of a training intervention for finding the missed cases of tuberculosis amongst patent medicine vendors in Delta State, Nigeria.

Context: The undiagnosed and untreated tuberculosis (TB) cases underpin the experience of accelerating deaths. Everyone should be engaged in managing TB patients to revert the current trend. Aims: In this context, we assessed the outcome of an education intervention on the knowledge of TB and referral practice of presumptive TB cases to directly observed therapy strategy amongst patent medicine vendors (PMVs). Settings and Design: The study was quasi-experimental, conducted amongst 647 PMVs in Delta State, Nigeria. Methods: A structured questionnaire was administered to obtain baseline data on knowledge of TB. An educational intervention on knowledge of TB was then given. A post-intervention assessment of TB knowledge was subsequently conducted using the same questionnaire. The exact number of referrals of presumptive TB cases by PMVs and the number that tested positive amongst the referred presumptive TB cases, 3 months before and after the training were obtained from the state TB database. Statistical Analysis Used: SPSS v. 26 was used for data analysis. Results: The pre-training knowledge average score was 15.45 ± 6.45, while the post-training average score was 19.44 ± 7.03 (P < 0.001). The pre-training average number of presumptive cases referred was 146 ± 124.7, and the post-training was 205.67 ± 255.4, P = 0.41. The pre-training average number of cases that turned out positive was 9.5 ± 6.3, and the post-training was 13.5 ± 11.3, P = 0.42. Conclusion: There was a significant improvement in PMVs' knowledge of TB post-intervention. However, while an increase in the number of cases referred and positives detected was observed, this was not significant. Periodic training and updates to PMVs in keeping with current trends and best practices in TB management are recommended.

Corrigendum: Caseload and Case Fatality of Lassa Fever in Nigeria, 2001-2018: A Specialist Center's Experience and Its Implications.

[This corrects the article DOI: 10.3389/fpubh.2019.00170.].

Caseload and Case Fatality of Lassa Fever in Nigeria, 2001-2018: A Specialist Center's Experience and Its Implications.

Background: The general lack of comprehensive data on the trends of Lassa fever (LF) outbreaks contrasts with its widespread occurrence in West Africa and is an important constraint in the design of effective control measures. We reviewed the contribution of LF to admissions and mortality among hospitalized patients from 2001 to 2018 in the bid to address this gap. Methods: Observational study of LF caseload and mortality from 2001 to 18 in terms of the contribution of confirmed LF to admissions and deaths, and case fatality (CF) among patients with confirmed LF at a specialist center in Nigeria. The diagnosis of LF was confirmed using reverse transcription polymerase chain reaction (RT-PCR) test, and medians and frequencies were compared using Kruskal-Wallis, Mann-Whitney and χ2 tests, with p-values <0.05 taken as significant. Results: The contribution of confirmed LF to deaths (362/9057, 4.0%) was significantly higher than to admissions (1,298/185,707, 0.7%; OR [95% CI] = 5.9 [5.3, 6.7], p < 0.001). The average CF among patients with confirmed LF declined from 154/355 (43%) in 2001-09 to 183/867 (21.1%) (OR [95% CI] = 2.9 [2.2, 3.7], p < 0.001) in 2011-18. The annual CF declined from 94% in 2001 to 15% in 2018 whereas the caseload increased from 0.3 to 3.4%. The outbreaks were characterized by irregular cycles of high caseload in 2005-2007, 2012-2014, and 2016-2018, and progressive blurring of the seasonality. Conclusion: LF outbreaks in Nigeria have upgraded spatially and temporally, with the potential for cycles of increasing severity. The strategic establishment of LF surveillance and clinical case management centers could be a pragmatic and cost-effective approach to mitigating the outbreaks, particularly in reducing the associated CF. Urgent efforts are needed in reinvigorating extant control measures while the search for sustainable solutions continues.