Potential risk factors for cardiovascular diseases and associated sociodemographic characteristics: A cross-sectional evaluation of a large cohort of women living with HIV in north-central Nigeria.

Males have a higher prevalence of cardiovascular (CVD) risk factors such as alcohol use, hypercholesterolemia, hypertension, obesity, and smoking based on limited data available from two tertiary health centers in Nigeria. Increasing age and lower educational level influence smoking among the same population in northeastern and northwestern Nigeria. Specifically in women living with HIV (WLHIV), the association between demographic characteristics and CVD risk factors has not been described. In a multi-center cross-sectional study, we documented the association of sociodemographic characteristics with potential CVD risk factors among a large cohort of WLHIV attending five treatment sites in north-central Nigeria. This was a cross-sectional study among 5430 women of reproductive age who received antiretrovirals at five selected treatment sites in Benue State, Nigeria. We performed multivariable regression of sociodemographic characteristics on potential cardiovascular risk factors, namely, smoking, alcohol consumption, and contraceptive use. We found participants' mean age was 33.2 (standard deviation: 6.1) years. Prevalence of smoking, alcohol consumption, and contraceptive use were 0.6%, 11%, and 7% respectively. Older WLHIV (≥ 40 years) had a negative association with contraceptive use (aOR: 0.58, 95%CI: 0.42-0.81). Being educated WLHIV had a positive association with contraceptive use (aOR: 1.34, 95%CI: 1.02-1.76) and a negative association with tobacco smoking (aOR: 0.37, 95%CI: 0.16-0.83). Being a farmer had a negative association with alcohol consumption (aOR: 0.43, 95%CI: 0.35-0.52) and contraceptive use (aOR: 0.61, 95%CI: 0.48-0.76). Compared to being married, being in a single relationship had positive association with alcohol consumption (aOR: 1.30, 95%CI: 1.08-1.56) while parenting was associated with 165% higher odds of contraceptive use (aOR: 2.65, 95%CI: 1.73-4.06). In conclusion, the low prevalence of smoking exists among women living with HIV on antiretroviral treatment. Older age, farming and being married are potential deterrents to lifestyle risk factors for cardiovascular diseases among this population. To improve HIV-related treatment efforts and outcomes, implementing interventions aimed at lifestyle behavioral modification among this population has the potential to reduce cardiovascular disease risks.

What makes a peer? Characteristics of certified peer recovery support specialists in an emergency department-based intervention.

Providing brief interventions by certified peer recovery support specialists (CPRSS) in the emergency department (ED) following a drug related visit is a promising method of service engagement and has garnered national attention. This study examines CPRSS's perceptions of the qualities that enable them to deliver interventions in the ED. We conducted qualitative interviews with 14 CPRSSs working in EDs. Interview topics included how the participants became involved with CPRSS work, experiences working in the ED, how the ED differs from other settings, and what interactions with patients look like. Interviews were digitally recorded, transcribed, and analyzed for emerging categories. Three categories were identified relating to CPRSS work: (1) how they approach peer work, (2) inherent qualities required to do the work, regardless of the setting, and (3) context-specific skills required to do the work in the ED. When describing their approach to this work, participants talked about CPRSS work as their life calling and their passion. Participants also identified certain qualities that all CPRSS workers possess, regardless of the setting, including the ability to build rapport, strong listening skills, and a shared lived experience. Lastly, participants identified how specific hard and soft skills help them to navigate organizational and structural challenges in the ED. The unique conditions of the ED and the required qualities of a CPRSS should be considered when implementing an ED-based intervention.

Improving health information system for malaria program management: Malaria Frontline Project lessons learned from Kano and Zamfara States, Nigeria, 2016-2019.

The U.S. Centers for Disease Control and Prevention in collaboration with the National Malaria Elimination Program and the African Field Epidemiology Network established the Malaria Frontline Project to provide innovative approaches to improve the malaria program implementation in Kano and Zamfara States, Nigeria. Innovative approaches such as malaria bulletin, malaria monitoring wall chart, conduct of ward level data validation meetings and malaria dashboard have helped improve the use of data for decision making at all levels. Innovative approaches deployed during the project implementation facilitated data analysis and a better understanding of malaria program performance and data utilization for decision making at all levels. These innovative approaches may improve malaria control program performance in Nigeria and other resource limited countries.

Estimating vaccine coverage in conflict settings using geospatial methods: a case study in Borno state, Nigeria.

Reliable estimates of subnational vaccination coverage are critical to track progress towards global immunisation targets and ensure equitable health outcomes for all children. However, conflict can limit the reliability of coverage estimates from traditional household-based surveys due to an inability to sample in unsafe and insecure areas and increased uncertainty in underlying population estimates. In these situations, model-based geostatistical (MBG) approaches offer alternative coverage estimates for administrative units affected by conflict. We estimated first- and third-dose diphtheria-tetanus-pertussis vaccine coverage in Borno state, Nigeria, using a spatiotemporal MBG modelling approach, then compared these to estimates from recent conflict-affected, household-based surveys. We compared sampling cluster locations from recent household-based surveys to geolocated data on conflict locations and modelled spatial coverage estimates, while also investigating the importance of reliable population estimates when assessing coverage in conflict settings. These results demonstrate that geospatially-modelled coverage estimates can be a valuable additional tool to understand coverage in locations where conflict prevents representative sampling.

Malaria Frontline Project: strategic approaches to improve malaria control program leveraging experiences from Kano and Zamfara States, Nigeria, 2016-2019.

BACKGROUND: The Malaria Frontline Project (MFP) supported the National Malaria Elimination Program for effective program implementation in the high malaria-burden states of Kano and Zamfara adapting the National Stop Transmission of Polio (NSTOP) program elimination strategies. PROJECT IMPLEMENTATION: The MFP was implemented in 34 LGAs in the two states (20 out of 44 in Kano and all 14 in Zamfara). MFP developed training materials and job aids tailored to expected service delivery for primary and district health facilities and strengthened supportive supervision. Pre- and post-implementation assessments of intervention impacts were conducted in both states. RESULTS: A total of 158 (Kano:83; Zamfara:75) and 180 (Kano:100; Zamfara:80) healthcare workers (HCWs), were interviewed for pre-and post-implementation assessments, respectively. The proportions of HCWs with correct knowledge on diagnostic criteria were Kano: 97.5% to 92.0% and Zamfara: 94.7% to 98.8%; and knowledge of recommended first line treatment of uncomplicated malaria were Kano: 68.7% to 76.0% and Zamfara: 69.3% to 65.0%. The proportion of HCWs who adhered to national guidelines for malaria diagnosis and treatment increased in both states (Kano: 36.1% to 73.0%; Zamfara: 39.2% to 67.5%) and HCW knowledge to confirm malaria diagnosis slightly decreased in Kano State but increased in Zamfara State (Kano: 97.5% to 92.0%; Zamfara: 94.8% to 98.8%). HCWs knowledge of correct IPTp drug increased in both states (Kano: 81.9% to 94.0%; Zamfara: 85.3% to 97.5%). CONCLUSION: MFP was successfully implemented using tailored training materials, job aids, supportive supervision, and data use. The project strategy can likely be adapted to improve the effectiveness of malaria program implementation in other Nigerian states, and other malaria endemic countries.

A Brief Intervention on E-Cigarette, Regular Cigarette, and Marijuana Use Results in Generalization Effects: Lateral Attitude Change among College Students.

OBJECTIVE: We hypothesized (1) perceived harm beliefs and intention to use e-cigarette attitudes will become more negative post-exposure to the intervention (2) this change will generalize to more negative beliefs and intention toward regular cigarettes and marijuana. METHODS: MANOVAs of students' perceptions of harm beliefs and intention toward the use of e-cigarettes and regular cigarettes, and marijuana were performed to ascertain change in harm beliefs before (t1) to after the intervention (t2) for 188 nonwhite Hispanic and White college students who viewed educational material (informational text + video), the intervention, during an online experimental survey. RESULTS: The first MANOVA yielded main effect with significant differences for substances, Wilks' Lambda (Λ) = 0.254, F = 234.920 (2, 160), p < 0.001, ηp2 =0.746 and by time (Λ = 0.740, F = 56.684 (1, 161), p < 0.001, ηp2 = 0.260). E-cigarettes, regular cigarettes, and marijuana were perceived more harmful for one's health and for the health of others at t2. The MANOVA on peer influence and intention to use (Λ = 0.277, F = 222.890 (2, 171), p < 0.001), ηp2 = 0.723) and by time (Λ = 0.922, F = 14.514 (1, 172), p < 0.001), ηp2 = 0.078) was significant. Respondents were less likely to use any of the substances if their best friend offered at t2. Intent for future use was also reduced at t2. CONCLUSION: A brief intervention potentiated favorable change in harm beliefs and intention to focal object (e-cigarettes) and lateral objects (regular cigarettes and marijuana).

The moderating role of partners' education on early antenatal care in northern Ghana.

BACKGROUND: Early antenatal care (ANC) is essential for improving maternal and child health outcomes. The primary aims of this study were to 1) estimate the association between partners' education attainment and early ANC, and 2) determine whether partners' level of education modified the relationship between mothers' education, mothers' age, planned pregnancy, employment status and early ANC. METHODS: Data were obtained from a cross-sectional study conducted from April to May 2021 among 519 mothers with a live birth in the past year in the Nabdam district in the Upper East Region in northern Ghana. Generalized estimating equations were used to assess whether partners' level of education modified the relationship between mothers' education, mothers' age, planned pregnancy, employment status and early ANC. Effect modification was assessed on the additive and multiplicative scales using adjusted prevalence ratios (aPR) and corresponding 95% confidence intervals. RESULTS: Mothers whose partners had secondary or higher education had a 26% higher prevalence of early ANC compared to mothers whose partners had less than a secondary level of education (aPR: 1.26, 95% CI: 1.05,1.51). There was evidence of effect modification by partners' education on the relationship between planned pregnancy and early ANC on both the additive (Relative excess risk due to interaction [RERI]: 0.61, 95% CI: 0.07,0.99), and multiplicative (ratio of PRs: 1.64, 95% CI: 1.01,2.70) scales. Among mothers whose partners had less than secondary education, mothers who had teenage pregnancy (i.e., aged 18-19 years old during pregnancy) were less likely to have early ANC compared to those who did not have teenage pregnancy (aPR: 0.71, 95% CI: 0.53,0.97). Among mothers whose partners had a secondary or higher education, early ANC was more prevalent among employed mothers compared to those who were unemployed (aPR: 1.27, 95% CI: 1.02,1.57). CONCLUSIONS: Our findings suggest that whilst mothers whose partners had a secondary or higher education were more likely to initiate early ANC, supporting such women to plan their pregnancies can further increase the coverage of early ANC.

Diabetes mellitus and its associated factors among patients with tuberculosis attending directly observed treatment centres in Oyo State, Nigeria: a cross-sectional evaluation.

OBJECTIVE: Diabetes mellitus (DM) and tuberculosis (TB) comorbidity is evolving into an emerging epidemic globally. In Nigeria, a high burden of both diseases, respectively, exists with limited information on tuberculosis-diabetes mellitus (TB-DM) comorbidity. We determined the fasting blood glucose (FBG) level among patients with TB and factors associated with TB-DM comorbidity in Oyo State, South-west Nigeria. METHODS: A cross-sectional study was conducted among patients with TB aged 15 years and above, who were selected using multistage sampling. Data were collected on patients' biodata, anthropometric measurements and FBG levels using a pretested semistructured questionnaire. The FBG test was conducted on patients with confirmed pulmonary TB (old and newly diagnosed patients with TB) at any stage of anti-TB treatment. Background characteristics and FBG level were summarised using descriptive statistics and factors associated with TB-DM comorbidity were examined at bivariate and multivariable analyses. RESULTS: Of the 404 patients with TB, 30 (7.4%) had impaired fasting glucose and 32 (7.9%) were diagnosed with diabetes. The mean age of the male and female respondents was 41 (±14.2) and 36.8 (±15.0), respectively. Females were more likely than males to have diabetes (10.6% vs 6.3%). Median FBG level for the patients was 88 (IQR: Q1: 99, Q3: 79) mg/dL. Age, marital status and educational level were not associated with TB-DM comorbidity. In the multivariable model, only normal body mass index was independently and significantly associated with diabetes. CONCLUSION: TB-DM was prevalent among the studied population in South-west Nigeria. We recommend the integration of DM screening within the continuum of care for TB management.

Identification of Non-Fatal Opioid Overdose Cases Using 9-1-1 Computer Assisted Dispatch and Prehospital Patient Clinical Record Variables.

Background: The current epidemic of opioid overdoses in the United States necessitates a robust public health and clinical response. We described patterns of non-fatal opioid overdoses (NFOODs) in a small western region using data from the 9-1-1 Computer Assisted Dispatch (CAD) record and electronic Patient Clinical Records (ePCR) completed by EMS responders. We determined whether CAD and ePCR variables could identify NFOOD cases in 9-1-1 data for intervention and surveillance efforts. Methods: We conducted a retrospective analysis of 1 year of 9-1-1 emergency medical CAD and ePCR (including naloxone administration) data from the sole EMS provider in the response area. Cases were identified based on clinician review of the ePCR, and categorized as definitive NFOOD, probable NFOOD, or non-OOD. Sensitivity, specificity, positive and negative predictive values (PPV and NPV) of the most prevalent CAD and ePCR variables were calculated. We used a machine learning technique-Random-Forests (RF) modeling-to optimize our ability to accurately predict NFOOD cases within census blocks. Results: Of 37,960 9-1-1 calls, clinical review identified 158 NFOOD cases (0.4%), of which 123 (77.8%) were definitive and 35 (22.2%) were probable cases. Overall, 106 (67.1%) received naloxone from the EMS responder at the scene. As a predictor of NFOOD, naloxone administration by paramedics had 67.1% sensitivity, 99.6% specificity, 44% PPV, and 99.9% NPV. Using CAD variables alone achieved a sensitivity of 36.7% and specificity of 99.7%. Combining ePCR variables with CAD variables increased the diagnostic accuracy with the best RF model yielding 75.9% sensitivity, 99.9% specificity, 71.4% PPV, and 99.9% NPV. Conclusion: CAD problem type variables and naloxone administration, used alone or in combination, had sub-optimal predictive accuracy. However, a Random Forests modeling approach improved accuracy of identification, which could foster improved surveillance and intervention efforts. We identified the set of NFOODs that EMS encountered in a year and may be useful for future surveillance efforts.

What do malaria program officers want to learn? A survey of perspectives on a proposed malaria short course in Nigeria.

BACKGROUND: In disease control, the program officers are vital to the successful implementation of control strategies. However, poor knowledge of the disease and its control, staff attrition, and lack of intentional training for new staff can lead to under-performance and ineffectiveness of interventions. Thus, the Nigeria Field Epidemiology and Laboratory Training Program, in collaboration with National Malaria Elimination Program, planned a malaria short course (MSC) to strengthen the capacity of current program managers and incoming staff. To guide the development of the curriculum for the MSC, we conducted a needs assessment survey to ascertain the perceived usefulness of the MSC, the priority rating of MSC thematic domains and associated factors. METHODS: Overall, 384 purposively selected respondents across ten states and the Federal Capital Territory in Nigeria were interviewed. These comprised malaria and non-malaria control program staff at state, local government area (LGA) and ward levels. We administered a structured questionnaire to elicit information on socio-demographics, training needs, priority malaria thematic domains, perceived course usefulness and willingness of ministries/organizations to release staff to attend the MSC. Data were analyzed using descriptive and inferential statistics at p<0.05. RESULTS: Mean age was 43.9 (standard deviation: 7.6 years), 172 (44.8%) were females. Of the 384 respondents, 181 (47.1%), 144 (37.5%) and 59 (15.4%) were at the ward, LGA and state levels, respectively. Seventy-two (18.8%) had never worked in malaria control program. Majority (98.7%, n = 379) reported the need for further training, 382 (99.5%) opined that the course would be useful, and all affirmed their employers' willingness towards their participation at the training. Respondents rated high the domains of basic malariology, malaria treatment, malaria prevention, surveillance/data management, use of computers, leadership skills, program management and basic statistics. Predictors of malaria topical domains' high rating were gender (odds ratio (OR) = 6.77; 95% CI:3.55-12.93) and educational qualifications (OR = 0.48; 95% CI:0.26-0.89). CONCLUSIONS: A malaria short course is a necessity and appropriate for program officers at different levels of health administration in Nigeria to achieve malaria elimination, taking into consideration the challenges of human resource retention. The outcome of this study should inform the curriculum and the delivery of the MSC.

Importance of Community-Level Interventions During the COVID-19 Pandemic: Lessons from Sub-Saharan Africa.

Community-level strategies are important in ensuring adequate control of disease outbreaks especially in sub-Saharan African countries. Learning from public health responses to previous infectious disease outbreaks is important in shaping these responses to COVID-19. This study aims to highlight and summarize the evidence from community-level interventions during infectious disease outbreaks in sub-Saharan Africa (SSA). We conducted a scoping review of published literature on community-level interventions and strategies adopted in different infectious disease outbreaks in SSA. To obtain relevant studies, we searched EMBASE, CINAHL, MEDLINE, and Google Scholar in August 2020. Our search was based on the combination of keywords such as coronavirus, flu, Ebola, community, rural, strategies, impact, effectiveness, feasibility, Africa, developing countries, and SSA. Studies that met the inclusion criteria were selected and synthesized under the following distinct themes: health education, sensitization, and communications; surveillance; and service delivery. Our review highlights community-based strategies that have been tried and tested with varying outcomes for different outbreaks in different sub-Saharan African communities, we believe they will inform the selection of strategies to adopt in managing the COVID-19 pandemic at the community level. The important aspects of these strategies were highlighted, requirements for successful implementation and the possible challenges that might be encountered were also discussed. Achieving control of the COVID-19 pandemic in sub-Saharan African communities, will require concerted community-based and community-led strategies, which in turn rely on the availability of necessary socioeconomic resources, and the contextual adaption of these interventions.

Geographical and temporal variation in reduction of malaria infection among children under 5 years of age throughout Nigeria.

INTRODUCTION: Global progress in reducing malaria has stalled since 2015. Analysis of the situation is particularly needed in Nigeria, the country with by far the largest share of the burden, where approximately a quarter of all cases in the world are estimated to occur. METHODS: We analysed data from three nationwide surveys (Malaria Indicator Surveys in 2010 and 2015 and a National Demographic and Health Survey in 2018), with malaria parasite prevalence in children under 5 years of age determined by sampling from all 36 states of Nigeria, and blood slide microscopy performed in the same accredited laboratory for all samples. Changes over time were evaluated by calculating prevalence ratio (PR) values with 95% CIs for each state, together with Mantel-Haenszel-adjusted PRs (PRadj) for each of the six major geopolitical zones of the country. RESULTS: Between 2010 and 2018, there were significant reductions in parasite prevalence in 25 states, but not in the remaining 11 states. Prevalence decreased most in southern zones of the country (South West PRadj=0.53; South East PRadj=0.59; South South PRadj=0.51) and the North Central zone (PRadj=0.36). Changes in the north were less marked, but were significant and indicated overall reductions by more than 20% (North-West PRadj=0.74; North East PRadj=0.70). Changes in the south occurred mostly between 2010 and 2015, whereas those in the north were more gradual and most continued after 2015. Recent changes were not correlated with survey-reported variation in use of preventive measures. CONCLUSION: Reductions in malaria infection in children under 5 have occurred in most individual states in Nigeria since 2010, but substantial geographical variation in the timing and extent indicate challenges to be overcome to enable global malaria reduction.

Maternal knowledge, attitude, and perception about childhood routine immunization program in Atakumosa-west Local Government Area, Osun State, Southwestern Nigeria.

Introduction: Routine Immunization (RI) is a key strategy in prevention of vaccine-preventable diseases (VPD). The Nigerian Demographic and Health survey 2013 showed that only 55% of children were fully immunized in Osun State. Historically, efforts to improve uptake of RI focused on health system factors with little attention on maternal related factors. This study assessed mothers´ knowledge, attitude, and perception towards the RI program in Atakumosa West Local Government Area (LGA) of Osun State. Methods: A total of 750 mothers were enrolled in a household survey using WHO cluster sampling in Atakumosa West LGA. Semi-structured questionnaires were used to obtain data on sociodemographic characteristics, knowledge on RI, attitudes, and perception of mothers towards RI program. Knowledge scores of ≥ 4 points based on six-point domain questions were regarded as good. Results: The mean (±SD) age of the mothers was 27.9 (± 6.1) years; 76% (571/750) had good knowledge of RI and VPD and a majority demonstrated a positive attitude towards the RI program. Antenatal care (ANC) attendance [OR 3.7; 95% CI (2.0 - 6.7)] health facility delivery [OR 1.7 (1.2 - 2.7)]; higher level of education [OR 1.9; 95% CI (1.4 - 2.5)], and mothers´ tetanus toxoid immunization status [OR 4.0 (2.3 - 7.2)] were significantly associated with having good knowledge of the RI program. Conclusion: A high proportion of mothers in Atakumosa West LGA of Osun State have good knowledge on childhood RI program. Current efforts at health education in ANC should be sustained and other strategies to improve knowledge on immunization need to be identified.

Malaria frontline project: pre-intervention Malaria baseline assessment in Kano and Zamfara States, August 2016.

Introduction: In 2016, the Centers for Disease Control and Prevention and the Government of Nigeria initiated the Malaria Frontline Project in Kano and Zamfara States. The project goal is to improve the quality and coverages of malaria interventions adapting polio program strategy. We conducted a baseline assessment of malaria interventions. Methods: Twenty-four primary health centers per State were selected using probability sampling. Health workers (HW) were purposively sampled to assess their knowledge of national malaria control guidelines. Clients were selected for exit interview to assess health workers´ adherence to the national guidelines. WHO cluster methodology was used to survey heads of household and women of reproductive age on knowledge of malaria prevention, Long Lasting Insecticidal Net (LLIN) ownership and use. Results: Of the 158 HW interviewed, 94.3% knew the correct criteria for malaria diagnosis, 86.1% reported using artemisinin-based therapy to treat uncomplicated malaria. About 45% of HW reported prescribing artemisinin-based combination therapy (ACT) for uncomplicated malaria in first trimester of pregnancy and 39% prescribed quinine. Only 73.9% of fever cases were referred to laboratory as recommended by the national guideline. Households with one LLIN per 2 persons (Kano: 27.1%; Zamfara: 30.0%), LLIN use (Kano: 70.8%; Zamfara: 81.6%) and IPTp1 (Kano: 38.6%; Zamfara: 33.3%). Conclusion: most clinicians have knowledge of national guidelines, but fewer adhere to guidelines in practice. Population LLIN ownership, LLIN use among pregnant women and IPTp are lower than the national targets of 58%, 83% and 75% respectively for 2016. We recommend improving health workers´ technical capacity and adherence to national malaria guidelines.

Enhancing acute flaccid paralysis surveillance through the use of pictorial surveillance reminder cards during supplementary immunization activities, December 2014: a survey in Jigawa State, Nigeria.

Introduction: Acute flaccid paralysis (AFP) pictorial surveillance reminder cards (AFP cards) could aid AFP case identification during supplementary immunization activities (SIAs). We assessed the availability and utilization of AFP cards among vaccination teams during the December 2014 polio SIAs in Jigawa State, Nigeria. Methods: We conducted a cross-sectional survey of a convenience sample of 95 vaccination team supervisors. We used a semi-structured interviewer-administered questionnaire to collect information on socio-demographics, knowledge of AFP cases, availability and utilization of the AFP cards for case identification and investigation and non-compliance resolution by vaccination teams. Univariate and bivariate analyses were performed using Epi Info version 3.5.1. Results: Of the 95 supervisors interviewed, 86 (91%) reported that vaccinators properly displayed the AFP cards, 90 (95%) reported use of cards for AFP case identification, 88 (93%) reported use of cards to resolve non-compliance with polio vaccination and 77 (81%) reported use of cards to ask caregivers six key questions to prevent missed children. Fifty-eight (61%) supervisors knew the AFP case definition. A total of 21 possible AFP cases were identified by vaccination team members with the aid of the cards, of which 17 (81%) were referred to the nearest health facility. Conclusion: The survey demonstrated usefulness of reminder cards for identification and follow-up of AFP cases. Based on these findings, use of AFP cards was implemented in all Nigerian States and similar cards were developed and implemented for measles surveillance during SIAs.

Malaria and COVID-19: commonalities, intersections and implications for sustaining malaria control.

The devastating impact of infectious disease outbreaks and pandemics on health systems could be overwhelming especially when there is an overlap in clinical presentations with other disease conditions. A case in point is the disruptive effect of the Ebola Virus Disease outbreak on health service delivery and its consequences for malaria management in the affected West and Central African countries between 2014 and 2016. This could be the case with the current infectious disease pandemic (COVID-19) the world is experiencing as malaria illness shares many symptoms with COVID-19 illness. Caused by a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), COVID-19 is reported to have originated from Wuhan city, China in December 2019. COVID-19 was declared a Public Health Emergency of International Concern on 30 January 2020 and declared a pandemic on March 11, 2020 by the World Health Organization (WHO). Practically, all community infrastructure has been activated in affected countries in response to COVID-19. However, the deployment of huge resources in combating COVID-19 pandemic should not be a missed opportunity for the advancement of infectious diseases control including malaria. This calls for conscious and heightened effort to sustain the gains in malaria control. The WHO has emphasized that the response to the COVID-19 pandemic must utilize and strengthen existing infrastructure for addressing malaria and other infectious diseases globally. Leveraging these to maintain malaria control activities in endemic countries could boost and help to sustain the gains in malaria control in accordance with the 2016-2030 Global technical strategy for malaria (GTS) milestones. In addition, it will help to keep the "High burden to high impact" (HBHI) and other initiatives on track. This article highlights the commonalities of the two diseases, discusses implications and recommendations to support decision making strategies to keep malaria control on track in the COVID-19 pandemic era.

Social approaches to COVID-19 pandemic response: effectiveness and practicality in sub-Saharan Africa.

INTRODUCTION: the threat of the coronavirus disease 2019 (COVID-19) pandemic to health systems and communities in sub-Saharan Africa (SSA) is enormous. Social approaches such as distancing measures are essential components of the public health response to respiratory-related infectious disease outbreaks. Due to socio-economic and broader peculiarities of SSA countries, social approaches that were effective elsewhere may have limited practicality in these contexts, and if practical; may yield different or even adverse results. We highlighted the effectiveness of these social approaches and their practicality in SSA. METHODS: we conducted a comprehensive literature search through multiple databases, to identify articles relevant to social distancing. Findings were thematically summarized. RESULTS: our review found emerging and varying empirical evidence on the effectiveness of social approaches in the control and mitigation of the COVID-19 pandemic; thus, limiting its applicability in SSA contexts. Nonetheless, our review demonstrates that the effectiveness and practicality of social approaches in SSA contexts will depend on available resources; timing, duration, and intensity of the intervention; and compliance. Weak political coordination, anti-science sentiments, distrust of political leaders and limited implementation of legal frameworks can also affect practicality. CONCLUSION: to overcome these challenges, tailoring and adaptation of these measures to different but unique contexts for maximum effectiveness, and investment in social insurance mechanisms, are vital.

Assessment of health service delivery parameters in Kano and Zamfara States, Nigeria.

BACKGROUND: In 2013, the Nigeria Federal Ministry of Health established a Master Health Facility List (MHFL) as recommended by WHO. Since then, some health facilities (HFs) have ceased functioning and new facilities were established. We updated the MHFL and assessed service delivery parameters in the Malaria Frontline Project implementing areas in Kano and Zamfara States. METHODS: We assessed all HFs in each of the 34 project local government areas (LGAs) between July and September 2017. Project staff administered a semi-structured questionnaire developed for this assessment to heads of HFs about the type of facility, category and number of staff working at the facility and to record geo-coordinates of facility. RESULTS: In the Kano State project area, 726 HFs were identified and geo-located: 31 were new facilities, 608 (84%), 116 (16%) and two (0.3%) were Primary Health Care (PHC), secondary and tertiary facilities respectively. Using the national definition, there were 710 (98%) functional facilities and 644 (91%) of these reported to the national health information platform, District Health Information System, version 2 (DHIS2). The Zamfara project area had 739 HFs: eight were new, 715 (97%), 22 (3.0%) and two (0.2%) PHCs, secondary and tertiary facilities respectively. There were 695 (94%) functional facilities with 656 (94%) of these reporting to DHIS2. Using national criteria for primary health care designation, only 95 (9%) of all PHCs in the two States met the minimum human resource requirements. CONCLUSION: Most HFs were functional and reported to DHIS2. A comprehensive MHFL having all the important parameters that should be established and updated regularly by authorities to make it more useful for health services administration and management. Most functional facilities are understaffed.

Rural-urban disparities and factors associated with delayed care-seeking and testing for malaria before medication use by mothers of under-five children, Igabi LGA, Kaduna Nigeria.

BACKGROUND: Fever in under-five children (U5) is the commonest presenting complaint in general practice and mothers' recognition is an entry point for fever treatment, including malaria. This study describes rural-urban disparity in fever prevalence in U5, mothers' malaria knowledge, care-seeking, testing for malaria before anti-malarial medication and the associated factors. METHODS: A cross-sectional survey was conducted among 630 mother-child pairs [rural (300) and urban (330)] selected randomly using a multi-stage sampling from 63 villages in Igabi LGA, Kaduna State, Nigeria. Trained female data collectors administered a pre-tested structured questionnaire to collect information on mother-child demographic profiles, malaria knowledge, fever episodes in birth order last child in two weeks prior to survey, blood testing before anti-malarial use, and delayed care-seeking defined as care sought for fever > 48 h of onset. Malaria knowledge was categorized into good, average, and poor if the final scores were ≥ 75th, 50th-74th, and < 50th percentiles, respectively. Frequency, proportions, and odds ratio were calculated. Statistically significant was set at p-value < 0.05. RESULTS: The median age (interquartile range) of rural mothers was 30 (IQR, 10) years compared to 27 (IQR, 6) years in urban. Of the 70.0% (441/629) U5 children with fever, 58.5% (258/441) were in rural settlements. A third of the mothers whose child had fever sought care. Mothers in rural settlements were 2.8 (adjusted OR: 2.8, CI 1.8-4.2, p < 0.01) times more likely to delay care-seeking for fever. Other significant factors were poor or no knowledge of malaria transmission, poor perception of malaria as a major health problem, and household size > 5. Also, mothers who had no formal education were four times more likely to receive anti-malarial medications without testing for malaria compared to their educated counterpart (adjusted OR: 4.0, 95% CI 1.6-9.9, p < 0.000). CONCLUSIONS: Rural-urban disparities existed between fever prevalence in U5 children, care-seeking practices by their mothers, and factors associated with delayed care-seeking and testing the fever for malaria before anti-malarial medication. Fever treatment for high impact malaria elimination in Nigeria needs a context-specific intervention rather than 'one-size-fits-all' approach.

Is the malaria short course for program managers, a priority for malaria control effort in Nigeria? Evidence from a qualitative study.

BACKGROUND: A Malaria Short Course (MSC) was conceptualized to build the capacity of program managers for malaria control due to the lack of a single comprehensive broad-based programmatic training in Nigeria. Prior to its implementation, a needs assessment was conducted based on the perspectives of stakeholders to plan and develop the curriculum. METHODS: This was an exploratory qualitative study. Fifty-six purposively selected stakeholders at local, state and national levels were interviewed. Opinions on the need for training, its perceived impact, priority focus, likelihood of participation, sustainability of and planned support for the MSC were explored using a pretested researcher-designed interview guide. Interviews were audiotape recorded, and the transcripts were subjected to thematic content analysis. RESULTS: Participants included Directors of Primary Health Care (50%), State Malaria Program Officers (8.9%), State Directors of Public Health Services (7.1%) and Roll Back Malaria Officers (5.4%). Participants' mean number of years of experience in their current positions was 6.2 (SD 4.7) years. The dominant view was "malaria remains a problem in Nigeria, exacerbated by poor funding, knowledge deficit, lack of training opportunities for program managers and prioritized training budget". A common viewpoint was "to achieve the malaria policy goals, MSC should focus on improving program managers' knowledge of the disease, novel interventions, data audit and use of data for decision making, supportive supervision as well as leadership and management skills. The prioritized thematic areas were malaria epidemiology, case management and data management. The consensus opinion was the MSC would have a positive impact on the performance of program managers. All managerial participants were willing to release their staff for the MSC and encouraged step-down training. However, most participants opined they could not guarantee that their institutions would provide financial support to the MSC attendees. CONCLUSIONS: Implementing the MSC for program managers was considered essential towards achieving malaria control. Moreover, there is need for prioritized funding and sustainability mechanisms to actualize the implementation of the course.