Perceptions of Nigerian medical students regarding their preparedness for precision medicine: a cross-sectional survey in Lagos, Nigeria.

BACKGROUND: Advances in precision medicine in Nigeria suggest improving genomics education and competency among healthcare practitioners to facilitate clinical translation. Due to the scarcity of research in this area, this study aimed to assess Nigerian medical students' perceptions about their preparedness to integrate precision medicine into their future clinical practice. METHODS: This was an institution-based cross-sectional study of medicine and surgery students in their clinical years attending the two fully accredited colleges of medicine in Lagos, Nigeria, between April and October 2022 using an adapted tool administered via Google Forms. The survey assessed their awareness, perceptions about knowledge, ability, and attitudes toward precision medicine, ethical concerns, and perceptions about their education in precision medicine. Multivariate linear regression models were used to assess factors associated with students' perceptions of their knowledge, ability, and attitudes. RESULTS: A total of 300 students completed the questionnaires with a response rate of 40%. Awareness of genomic medicine terminology was high (92.0%). Responses to knowledge and ability questions revealed notable gaps, however, respondents had positive attitude scores overall. Higher medical school year was independently associated with lower knowledge (ptrend = 0.003) and ability (ptrend = 0.005) scores, and knowledge score was independently associated with a higher ability score (ß: 0.76 95%CI: 0.67, 0.84; p < 0.001). Attitude scores significantly increased with increasing medical school year (ptrend = 0.04). The respondents mostly indicated concerns about government and corporate bodies' misuse of genomic data (35.7%) and the widening of socioeconomic disparities (34.0%). Although 65.0% of the respondents thought it important to learn about precision medicine, only 11.3% felt that their education had adequately prepared them for precision medicine, knew who to ask questions regarding genomic testing (10.7%), and felt their professors had encouraged the use of precision medicine (10.3%). CONCLUSION: Despite high awareness of precision medicine terminology and overall positive attitudes, our findings highlight gaps in knowledge and ability to integrate genomics into the care of patients and a need to improve precision medicine education among Nigerian medical students.

A cross-country qualitative analysis of teachers' perceptions of asthma care in sub-Saharan Africa.

Asthma is the most common chronic respiratory disease among school-going adolescents worldwide. However, the burden of severe asthma is highest in Sub-Saharan Africa. This study aimed to explore teachers' perceptions of asthma care across six African countries. We conducted focus group discussions (FGDs) using a semi-structured interview guide. Interviews were audio-recorded, transcribed verbatim and analysed thematically. FGDs were conducted in Kumasi(Ghana), Blantyre (Malawi), Lagos (Nigeria), Durban (South Africa), Kampala (Uganda), and Harare (Zimbabwe) between 01 November 2020 and 30 June 2021. We identified two key themes related to asthma care; barriers to asthma care and suggestions to improve the care of adolescents with asthma. Barriers reported by teachers included a lack of knowledge and skills among themselves, adolescents, and caregivers. In addition, some traditional beliefs of teachers on asthma exacerbated challenges with asthma care in schools. Regarding suggestions, most teachers identified a need for all-inclusive asthma training programmes for teachers, adolescents and caregivers, focusing on acute episodes and mitigating triggers. Utilising teachers with personal experiences with asthma to advocate and support these initiatives was suggested. Further suggestions included the need for annual screening to enable early identification of adolescents with asthma and clarify restrictions on teachers administering asthma medications. Teachers across African schools identify multiple barriers to asthma care. Structured school education programs and annual asthma screening are key to addressing some barriers to care.

Barriers to childhood asthma care in sub-Saharan Africa: a multicountry qualitative study with children and their caregivers.

OBJECTIVES: This study identifies barriers and provides recommendations to improve asthma care in children across sub-Saharan Africa, where qualitative data is lacking despite high rates. DESIGN: One of the aims of our National Institute for Health Research global health research group 'Achieving Control of Asthma in Children in Africa' was to use qualitative thematic analysis of transcribed audio recordings from focus group discussions (FGDs) to describe barriers to achieving good asthma control. SETTING: Schools in Blantyre (Malawi), Lagos (Nigeria), Durban (South Africa), Kampala (Uganda) and Harare (Zimbabwe). PARTICIPANTS: Children (n=136), 12-14 years with either asthma symptoms or a diagnosis and their caregivers participated in 39 FGDs. All were recruited using asthma control questions from the Global Asthma Network survey. RESULTS: There were four key themes identified: (1) Poor understanding, (2) difficulties experienced with being diagnosed, (3) challenges with caring for children experiencing an acute asthma episode and (4) suboptimal uptake and use of prescribed medicines. An inadequate understanding of environmental triggers, a hesitancy in using metred dose inhalers and a preference for oral and alternate medications were identified as barriers. In addition, limited access to healthcare with delays in diagnosis and an inability to cope with expected lifestyle changes was reported. Based on these findings, we recommend tailored education to promote access to and acceptance of metred dose inhalers, including advocating for access to a single therapeutic, preventative and treatment option. Furthermore, healthcare systems should have simpler diagnostic pathways and easier emergency access for asthma. CONCLUSIONS: In a continent with rapidly increasing levels of poorly controlled asthma, we identified multiple barriers to achieving good asthma control along the trajectory of care. Exploration of these barriers reveals several generalisable recommendations that should modify asthma care plans and potentially transform asthma care in Africa. TRIAL REGISTRATION NUMBER: 269211.

Hepatitis B and C seroprevalence among residents in Lagos State, Nigeria: A population-based survey.

Background: Hepatitis is one of the leading causes of morbidity and mortality, particularly in developing countries. It is often caused by hepatitis B and C, which are both preventable and treatable. Available information on Hepatitis B and C in Nigeria is based primarily on estimates obtained from specific population sub-groups or hospital-based surveys leaving gaps in population-level knowledge, attitudes, and prevalence. This study aimed to assess the knowledge, attitude and associated factors of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections amongst residents of Lagos State. Methodology: This was a community-based descriptive cross-sectional study carried out in all the 20 local government areas of Lagos state using a multistage sampling technique. Data were collected using pre-tested interviewer-administered questionnaires. Blood samples were taken (pinprick) from respondents (n = 4862) and tested using hepatitis B and C surface antigen tests after obtaining informed consent. Results: The overall prevalence of HBV infection in Lagos State was 2.1% while the prevalence of HCV infection was 0.1%. Only about half of all the respondents (50.9%) had heard about hepatitis B before the survey. Knowledge of the specific symptoms of HBV was also very low. For instance, only 28.1% of the respondents knew that yellowness of the eyes is associated with hepatitis while < 1% (0.1%) knew that HBV infection is associated with the passage of yellow urine. The most common source of information about hepatitis was the radio (13.0%). Only 36.2% of the respondents knew that HBV infection could be prevented. Overall, 28.8% of the respondents were aware of the hepatitis B vaccine. Less than half (40.9%) felt it was necessary to get vaccinated against HBV, however, a similar proportion (41.9%) would want to be vaccinated against HBV. Only 2.5% of all the respondents had ever received HBV vaccines while 3.5% had ever been tested for hepatitis B before this survey. There was a statistically significant association between HBV infection and respondents' use of shared clippers and work exposure involving contact with body parts and body fluids (P < 0.05). Conclusion: The knowledge, awareness and risk perception of HBV infection were low, however, almost half of the residents were willing to receive hepatitis B vaccinations if offered. It is recommended that the population-based prevention programmes and regular community-based surveillance be conducted by the public health department of Lagos State Ministry of Health. In addition, the strengthening of routine immunisation and vaccination of high-risk groups should be prioritised.

We love orthodox medicine but still use our 'Elewe omo': Utilization of traditional healers among women in an urban community in Nigeria.

Background: Traditional Medicine refers to knowledge, skills and practices based on the theories, beliefs and experiences indigenous to different cultures. Women have been reported to utilize orthodox health care facilities more hence this study in an urban center. Objective: To determine the utilization of traditional healers, preference of healthcare and co-utilization of traditional and orthodox medicine among women in an urban community in Lagos, Nigeria. Method: A cross sectional design using a multistage sampling to select 270 women in Mosan Okunola, Lagos, Nigeria in 2019. A pretested semi-structured intervieweradministered questionnaire and an in-depth interview were used to obtain data from participants. Utilization of traditional healers was referenced within the last 12 months. Result: Sixty three percent (63.2%) of the study population utilized traditional healers and 80.6% of respondents that accessed healthcare utilized traditional healers. The Traditional Medicine ingredient dealer was the most patronized (74.6% of respondents). Eighty three percent (83.3%) of study participants indicated preference for orthodox medicine and 53.1% of the study respondents co-utilized both traditional healers and orthodox medicine. Concurrent use of both traditional and orthodox medicine was not a common practice among the women. Level of education, monthly income and means of payment for treatment had a statistical significant association (P < 0.05) with utilization of traditional healers but means of payment for treatment was the singular predictive factor of utilization of traditional healers. Conclusion: Utilization of traditional healers among women in this community was high with majority indicating a preference for orthodox medicine. It is recommended that an in-depth history of remedies used by patients should be delved into by orthodox health practitioners.

Outcomes of COVID-19 patients with comorbidities in southwest Nigeria.

BACKGROUND: Data on the comorbidities that result in negative outcomes for people with COVID-19 are currently scarce for African populations. This study identifies comorbidities that predict death among a large sample of COVID-19 patients from Nigeria. METHODS: This was a retrospective analysis of medical records for 2184 laboratory confirmed cases of COVID-19 in Lagos, southwest Nigeria. Extracted data included age, sex, severity of condition at presentation and self-reported comorbidities. The outcomes of interest were death or discharge from facility. RESULTS: Most of the cases were male (65.8%) and the median age was 43 years (IQR: 33-55). Four hundred and ninety-two patients (22.5%) had at least one comorbidity and the most common amongst them were hypertension (74.2%) and diabetes (30.3%). The mortality rate was 3.3% and a significantly higher proportion of patients with comorbidities died compared to those with none. The comorbidities that predicted death were hypertension (OR: 2.21, 95%CI: 1.22-4.01), diabetes (OR: 3.69, 95% CI: 1.99-6.85), renal disease (OR: 12.53, 95%CI: 1.97-79.56), cancer (OR: 14.12, 95% CI: 2.03-98.19) and HIV (OR: 1.77-84.15]. CONCLUSION: Comorbidities are prevalent and the associated risk of death is high among COVID-19 patients in Lagos, Nigeria. Public enlightenment, early identification and targeted care for COVID-19 cases with comorbidities are recommended as the pandemic evolves.

Predictors of COVID-19 Information Sources and Their Perceived Accuracy in Nigeria: Online Cross-sectional Study.

BACKGROUND: Effective communication is critical for mitigating the public health risks associated with the COVID-19 pandemic. OBJECTIVE: This study assesses the source(s) of COVID-19 information among people in Nigeria, as well as the predictors and the perceived accuracy of information from these sources. METHODS: We conducted an online survey of consenting adults residing in Nigeria between April and May 2020 during the lockdown and first wave of COVID-19. The major sources of information about COVID-19 were distilled from 7 potential sources (family and friends, places of worship, health care providers, internet, workplace, traditional media, and public posters/banners). An open-ended question was asked to explore how respondents determined accuracy of information. Statistical analysis was conducted using STATA 15.0 software (StataCorp Texas) with significance placed at P<.05. Approval to conduct this study was obtained from the Lagos State University Teaching Hospital Health Research Ethics Committee. RESULTS: A total of 719 respondents completed the survey. Most respondents (n=642, 89.3%) obtained COVID-19-related information from the internet. The majority (n=617, 85.8%) considered their source(s) of information to be accurate, and 32.6% (n=234) depended on only 1 out of the 7 potential sources of COVID-19 information. Respondents earning a monthly income between NGN 70,000-120,000 had lower odds of obtaining COVID-19 information from the internet compared to respondents earning less than NGN 20,000 (odds ratio [OR] 0.49, 95% CI 0.24-0.98). In addition, a significant proportion of respondents sought accurate information from recognized health organizations, such as the Nigeria Centre for Disease Control and the World Health Organization. CONCLUSIONS: The internet was the most common source of COVID-19 information, and the population sampled had a relatively high level of perceived accuracy for the COVID-19 information received. Effective communication requires dissemination of information via credible communication channels, as identified from this study. This can be potentially beneficial for risk communication to control the pandemic.

Health literacy: Prevalence and determinants in Lagos State, Nigeria.

BACKGROUND: Poor health literacy has been associated with poorer physical and mental health function, and higher emergency department and hospital utilizations. The study was conducted to measure the prevalence of health literacy and its determinants among Lagos State residents. METHODS: A descriptive cross-sectional study was conducted in three local government areas in Lagos State. Health literacy was assessed using the Brief Health Literacy Screening tool (BHLS), a three-item tool with possible scores ranging between 3 and 15. Health literacy was classified as inadequate (≤ 9) or adequate (>9). RESULTS: A total of 1831 respondents participated in the study, among whom, 952 (52%) were women. The mean age of respondents was 31.7 (±10.5) years. Three-quarters (74.8%) of respondents had adequate health literacy. Adequate levels of health literacy were associated with being female (OR, 1.35; 95% CI, 1.07-1.71), frequent use of the broad cast media as source of information (OR, 1.33; 95% CI, 1.03-1.70), frequent use of the internet as source of information (OR, 1.49; 95% CI, 1.13-1.96). Adequate health literacy was also associated with having knowledge of a frequently prescribed antibiotic (OR, 1.67; 95% CI, 1.32-2.12) and being more comfortable with the use of the English language (OR, 1.71; 95% CI, 1.32-2.22). CONCLUSION: Gender, the use of broadcast media and the internet are predictive of adequate health literacy and should be taken into consideration in planning health interventions.

Nuances of reproductive decisions by women in a rural community of Lagos, Nigeria.

INTRODUCTION: inadequate utilization of maternal health services due to limited reproductive decision-making capacity could be contributory to high maternal mortality in developing countries. This study sought to assess nuances of reproductive decisions by women in a rural community of Lagos, Nigeria. METHODS: this descriptive, cross-sectional house to house survey was part of a study conducted in April 2015 on females selected from 298 households chosen based on geographical clusters by simple random sampling. The study instrument was adapted from a USAID-funded project and was interviewer-administered. Data entry and analysis were performed with the aid of Epi-info™ 7.0.8.3 statistical software and ethical approval was obtained for the study. RESULTS: spousal age difference was less than 10 years for about half (51.3%) of the respondents. The majority (91.6%) of the respondents had received antenatal care during pregnancy and jointly decided with their spouses on place of care. The most commonly used contraceptives were the pills (23.5%), injectables (16.8%) and condoms (13.8%). Spousal disapproval regarding the use of family planning was almost nil at 1%. Employment status as a socio-economic factor did not significantly affect respondents´ involvement in decision-making. However, there were statistically significant associations between spousal age differences and some indicators of autonomy such as respondents´ involvement in health care decisions and the determinant on choice of antenatal care provider. CONCLUSION: women´s reproductive independence and involvement in health decisions could result in reduction of maternal ill-health and mortality whilst promoting higher male involvement and better maternal health.

Characteristics of Mycobacterium Tuberculosis Positive Patients Screened for Drug-Resistant Tuberculosis at a Tertiary Health Facility in Lagos, Nigeria.

BACKGROUND: Nigeria is one of the ten countries with the highest tuberculosis (TB) burden globally and is experiencing an increasing incidence of drug resistance. This study aimed to determine the prevalence of mycobacterium tuberculosis and rifampicin resistance (DR-TB) among patients screened at the TB clinic of a tertiary institution in Lagos, South-West, Nigeria. METHODS: A review of records of 840 patients with suspected drug-resistant TB was carried out from Gene Xpert test clinic register at a tertiary health facility from November 2013 to April 2015. The Data was analyzed with SPSS version 20, Chi square test was used to determine association between DR-TB and the factors examined and the level of significance was set at P < 0.05. RESULTS: MTB detection among all screened suspects was 43.3%. The prevalence of rifampicin resistance was 17.6% among patients that were investigated for DR-TB and this occurred more in the working age group (15-54 years) with male to female ratio of 1.8:1. However, only history of close contact with known DR-TB patient was associated with DR-TB (P < 0.01). CONCLUSION: The burden of DR-TB may be higher than previously thought. Drug resistance testing should be made more available to detect cases and thus control the emerging problem.

Factors affecting utilization of youth friendly health services in Lagos State, Nigeria.

Background Youth friendly health services (YFHS) are services that attract, respond to the needs of and retain young people for continuing care. This study was conducted to determine the factors affecting utilization of government (GYFF) and non-governmental youth friendly facilities (NGYFF) in Lagos state, Nigeria. Methods A descriptive cross-sectional study was conducted. A total of 543 adolescents aged 15-24 years, between August 1, 2014 and October 31, 2014 were consecutively recruited from 10 (five government and five non-governmental) youth friendly health facilities that had been in operation for at least 6 months prior to the study. Logistic regression was used to determine predictors of utilization of youth friendly health facilities. Results Overall, the mean age of respondents was 17.9 ± 2.8. However, the mean age of respondents at GYFF (18.5 ± 3.0) was significantly higher than those at NGYFF (17.1 ± 2.5) (p < 0.001). Of the 567 youths enrolled, 196 (34.6%) had good utilization of youth friendly facilities (YFF) (34% from the GYFF and 35.2% from the NGYFF). Marital status, school attendance, having a baby, satisfaction with visit, perception that information shared was kept confidential and accessibility of the youth friendly services were associated with utilization of YFF (p < 0.05). Confidentiality and access to facilities were predictors of utilization of YFF. Conclusion There is poor utilization of both government and non-governmental youth friendly services in Lagos, Nigeria. There is a need for both the government and private sector to harmonize resources aimed at encouraging utilization of YFF in Lagos, Nigeria.

Causative factors for sexual and reproductive health status of pregnant adolescent girls in urban communities of Lagos, Nigeria.

Background The overall goal of this study was to determine the causative factors for pregnancy status in adolescent girls in two communities in the Lagos Island local government area. Methods A mixed methods (quantitative and qualitative) study reviewing routine health facility antenatal care (ANC) records and conducting focus group discussions among 46 pregnant adolescents, exploring their views about sex, contraception, pregnancy and sexual and reproductive health (SRH) services, was carried out. Key informant interviews were also carried out among healthcare workers and community members to assess their perceptions of adolescents' SRH problems. Results Five percent of those accessing ANC services were adolescents. Pregnant adolescents were found to access health services at later stages of their pregnancies due to the shame and stigma associated with their condition. The presence of morbidity in the form of anaemia (33%) and HIV (2.4%) was also found in this population. Social factors such as peer pressure and the desire to develop or maintain a relationship were found to be the major reasons for initiation of sexual activity by the adolescents. There was generally poor knowledge and utilisation of contraceptives, leading to unprotected sex and, thus, unintended pregnancies. Conclusion SRH information and services should be made readily available to adolescents at all levels of care.

A malariometric survey of under-fives residing in indoor residual spraying-implementing and non-implementing communities of Lagos, Nigeria.

BACKGROUND: Indoor residual spraying (IRS) is used as part of the integrated vector management strategy for the control of malaria in Lagos, Nigeria. The purpose of this study was to compare the malariometric indices of children under 5 years old living in IRS-implementing and non-IRS-implementing communities of Lagos, Nigeria. METHODS: The study was a community-based, comparative, cross-sectional study of 480 children under five recruited using a multi-stage sampling method. Data on each child were collected using a household questionnaire administered to the consenting care-giver of each selected child. Each child underwent a comprehensive physical examination. On-the-spot malaria rapid diagnostic testing and haemoglobin estimation to assess parasitaemia and anaemia, respectively, were also carried out. Risk factors for parasitaemia and anaemia were identified using multivariate logistic regression. RESULTS: A total of 238 children were studied in the IRS-implementing group while 242 children were studied in the non-IRS-implementing group. The IRS -implementing community had a lower level of parasitaemia (1.3 %) compared to the non-IRS-implementing community (5.8 %) (p < 0.001). There was no significant difference in anaemia, spleen rate and fever in the IRS-implementing group (10.9, 9.7 and 5 %) and the non-IRS-implementing group (9.9, 8.8 and 8.7 %), respectively. Residing in an IRS-implementing community was associated with lower odds of parasitaemia (OR 0.17, p < 0.01). Sleeping under a bed net was the only factor associated with anaemia (p < 0.01). CONCLUSION: IRS has led to a reduction in the level of parasitaemia in the under-fives in the study areas.

Youth friendly health services in a rural community of Lagos, Nigeria: are the youths receptive?

BACKGROUND: Globally, the youths constitute a major segment of most societies particularly in developing countries. This study was undertaken to assess the perception and practices related to youth friendly health services (YFHS) by in-school adolescents in a rural community of Lagos, Nigeria. METHODS: A descriptive cross-sectional survey was conducted on 400 proportionately selected consenting respondents from the senior classes of the three secondary schools in Agbowa community. A pre-tested interviewer-administered questionnaire was used for data collection and analysis was done with the aid of statistical software. RESULTS: Most of the respondents were in the age range of 12-15 years with mean age being 15.33±1.54 years. About half (46.8%) of the respondents correctly described adolescents as persons between the ages of 10 and 19 years. The majority (83.2%) of the respondents first heard about the Youth Friendly Health facilities from parents, guardians and friends. However, only few of the respondents had ever visited a Youth Friendly Center. A good location, convenient hours and comfortable surroundings were the most appealing aspects of YFHS. The provision of a seminar room and educational materials (60.8% and 70.8%, respectively) are important to the respondents. Reproductive health (56.8%) was the most preferred health education topic chosen by the respondents. CONCLUSION: Sensitization of the youths in the Agbowa community about youth friendly health services and provision of such services would be useful in reducing risky practices and improving their health.

Cervical Ectropion and Intra-Uterine Contraceptive Device (IUCD): a five-year retrospective study of family planning clients of a tertiary health institution in Lagos Nigeria.

BACKGROUND: Cervical ectropion (also known as cervical erosion) is a common finding on routine pelvic examination during the fertile years. The decision to treat or not remains controversial. According to studies in support of routine treatment of cervical erosion, there is a possible relationship between squamous metaplasia and squamous cell carcinoma of the cervix. To determine the prevalence of cervical ectropion and associated risk factors among clients with intra-uterine contraceptive devices (IUCDs) attending a family planning clinic of a tertiary health institution in Lagos, Nigeria. METHODS: A 5-year retrospective study was conducted by assessing existing clinic records from years 2007-2011. Clients with IUCDs undergo routine pelvic examination during check-up visits. A total of 628 clients' records were seen within the stated time frame. This study was approved by the ethical committee of the Lagos State University Teaching Hospital (LASUTH) and the collected data were analyzed using SPSS version 19.0. RESULTS: The mean age of the IUCD users was 34.7±6.52 years, while 517 (82.3%) had secondary education. On routine pelvic examination, seventy-nine clients (12.6%) had cervical ectropion. Thirty-nine (6.2%) clients had presented with a history of abnormal vaginal bleeding while 12.1% had vaginal discharge. Treatments offered to cases of cervical ectropion include cervical painting with gentian violet (89.9%) and antibiotics prescription (58.2%). On bivariate analysis, previous hormonal contraceptive use (P=0.041) and vaginal discharge (P<0.001) were significantly associated with developing cervical ectropion. Clients with ectropion were significantly more likely to receive prescriptions for antibiotics (P<0.001). CONCLUSION: Less than one fifth of the clients had cervical erosion. However, routine pelvic examination could aid the detection and control of latent reproductive health problems such as cervical ectropion which may require further investigations for example, pap smears, to exclude potentially lethal conditions and to determine appropriate treatment modality.

Factors Influencing Quality of Life and Predictors of Low Quality of Life Scores in Patients on Treatment for Pulmonary Tuberculosis: A Cross Sectional Study.

There is paucity of information on the quality of life of patients with pulmonary tuberculosis in Nigeria. This study assessed the factors influencing their quality of life and the independent predictors of low quality of life scores. Two hundred and sixty consecutive patients with pulmonary tuberculosis seen at the Lagos University Teaching Hospital were evaluated for health related quality of life using the World Health Organization Quality of life instrument (WHOQoL-BREF). Sociodemographic characteristics of the patients were related to the various domains of quality of life and a multivariate logistic regression analysis was performed to identify the independent predictors of low quality of life scores in the patients. The mean age of the patients was 36.7±12 years. Sex, age and marital status of patients were found to influence quality of life scores. The independent predictors of low quality of life scores were low monthly income, duration of the illness, concomitant illnesses, unemployment, advancing age and male gender. Several socio demographic and economic factors influenced the quality of life of patients with tuberculosis and are predictive of poor scores. It is important to consider these factors when treating patients with tuberculosis to optimise outcome of care.

Safety and immunogenicity of 10-valent pneumococcal nontypeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) in Nigerian children: Booster dose and 2-dose catch-up regimens in the second year of life.

In a previous study, 3-dose primary vaccination of Nigerian infants with the 10-valent pneumococcal nontypeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) was immunogenic for vaccine pneumococcal serotypes, with comparable tolerability between PHiD-CV and control groups. In an open-label study (ClinicalTrials.gov, NCT01153893), 68 primed children received a PHiD-CV booster dose co-administered with a diphtheria-tetanus-acellular pertussis (DTPa) booster dose at 15-21 months and 36 children unprimed for pneumococcal vaccination received two PHiD-CV catch-up doses (first dose co-administered with DTPa booster dose) at 15-21 and 17-23 months. Adverse events were recorded and immune responses were measured before and one month after vaccination. In both groups, pain was the most frequent solicited local symptom and fever was the most frequent solicited general symptom after the booster dose and each catch-up dose. Few grade 3 solicited symptoms and no vaccine-related serious adverse events were reported. After booster vaccination, for each vaccine serotype, at least 98.5% of children had an antibody concentration ≥ 0.2 µg/ml and at least 94.0% had an opsonophagocytic activity (OPA) titer ≥ 8. After 2-dose catch-up, for each vaccine serotype, at least 97.1% had an antibody concentration ≥ 0.2 µg/ml, except for serotypes 6B (82.9%) and 23F (88.6%), and at least 91.4% had an OPA titer ≥8, except for serotypes 6B (77.4%) and 19F (85.3%). PHiD-CV induced antibody responses against protein D in both groups. In conclusion, PHiD-CV administered to Nigerian toddlers as a booster dose or 2-dose catch-up was well tolerated and immunogenic for vaccine pneumococcal serotypes and protein D.

Primary vaccination with the 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) in infants in Mali and Nigeria: a randomized controlled trial.

BACKGROUND: Pneumonia is still the leading cause of death among children in Africa, and pneumococcal serotypes 1 and 5 are frequently isolated from African children with invasive pneumococcal disease below the age of 5 years. The immunogenicity, safety and reactogenicity of 3-dose primary vaccination with the 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) were evaluated in infants in Mali and Nigeria. METHODS: In an open, randomized, controlled study, 357 infants received DTPw-HBV/Hib and OPV primary vaccination with (PHiD-CV group) or without (control group) PHiD-CV co-administration at 6, 10 and 14 weeks of age. Pneumococcal antibody responses and opsonophagocytic activity (OPA) were measured and adverse events (AEs) recorded. RESULTS: One month post-dose 3, ≥ 97.2% of PHiD-CV-vaccinated infants had an antibody concentration ≥ 0.2 µg/mL for each vaccine pneumococcal serotype except for 6B (82.0%) and 23F (87.6%) versus < 10% in the control group except for serotypes 14 (35.7%) and 19F (22.5%). For each vaccine serotype, ≥ 93.3% of PHiD-CV recipients had an OPA titre ≥ 8, except for serotypes 1 (87.6%) and 6B (85.4%), compared to < 10% in the control group, except for serotypes 7F (42.9%), 9V (24.1%) and 14 (24.5%). Anti-protein D geometric mean antibody concentrations were 3791.8 and 85.4 EL.U/mL in the PHiD-CV and control groups, respectively. Overall incidences of solicited and unsolicited AEs were similar between groups. CONCLUSIONS: In sub-Saharan African infants, PHiD-CV was immunogenic for all vaccine pneumococcal serotypes and protein D. Vaccine tolerability was generally comparable between the PHiD-CV and control groups. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00678301.

Awareness and uptake of the Pap smear among market women in Lagos, Nigeria.

Our study evaluates the effect of an educational programme on awareness and uptake of the cervical cancer screening test (Pap smear) by women in a model market in Lagos, Nigeria. This was a quasi-experimental study using a multistage sampling technique. A total of 350 women were divided into two groups. A baseline survey on awareness of the Pap test and screening practices was carried out using pre-tested, interviewer administered, structured questionnaires. Participants in the intervention group received sessions of community based health information on cervical cancer screening tests while participants in the control group received health information on hypertension. Subsequently, participants in both groups were reassessed to evaluate the effect of the educational programme on the Pap test and cervical screening uptake. Data were analysed with the Epi-info version 6.04. Awareness about the Pap test was low at baseline; only 6.9% and 12.0% of participants in the intervention and control groups, respectively, had heard of Pap smears. Furthermore, less than 10% had correct information on the use of the Pap test. Post-intervention, there was a significant and proportional increase in the knowledge of the Pap test in the intervention group (P<0.05). However, uptake of the test was quite low in the intervention and control groups both pre- and post-intervention and there was no significant change in uptake. We concluded that essential schemes are required to enhance access to screening, as knowledge alone is insufficient to promote acceptance and use of cervical cytological screening tests.

Awareness and Uptake of the Pap Smear among Market Women in Lagos; Nigeria

Our study evaluates the effect of an educational programme on awareness and uptake of the cervical cancer screening test (Pap smear) by women in a model market in Lagos Nigeria. This was a quasi-experimental study using a multistage sampling technique. A total of 350 women were divided into two groups. A baseline survey on awareness of the Pap test and screening practices was carried out using pre-tested; interviewer administered; structured questionnaires. Participants in the intervention group received sessions of community based health information on cervical cancer screening tests while participants in the control group received health information on hypertension. Subsequently; participants in both groups were reassessed to evaluate the effect of the educational programme on the Pap test and cervical screening uptake. Data were analysed with the Epi-info version 6.04. Awareness about the Pap test was low at baseline; only 6.9and 12.0of participants in the intervention and control groups; respectively; had heard of Pap smears. Furthermore; less than 10had correct information on the use of the Pap test. Post-intervention; there was a significant and proportional increase in the knowledge of the Pap test in the intervention group (p