Using community theater to improve demand for vaccination services in the Niger Delta Region of Nigeria.

INTRODUCTION: Despite abundant evidence showing immunization as a lifesaving public health measure, a large proportion of Nigerian children are still not or fully vaccinated. Lack of awareness and distrust of the immunization process by caregivers are some of the reasons for poor immunization coverage which need to be addressed. This study aimed at improving vaccination demand, acceptance and uptake in Bayelsa and Rivers State, both in the Niger Delta Region (NDR) of Nigeria through a human-centered process of trust building, education and social support. METHODS: A quasi-experimental intervention christened Community Theater for Immunization (CT4I) was deployed in 18 selected communities between November 2019 and May 2021 in the two states. In the intervention localities, relevant stakeholders including the leadership of the health system, community leaders, health workers and community members were engaged and actively involved in the design and performance of the theaters. The content for the theater showcased real stories, using a human-centered design (HCD) of ideation, co-creation, rapid prototyping, feedback collection and iteration. Pre- and post-intervention data on the demand and utilization of vaccination services were collected using a mixed method. RESULTS: In the two states, 56 immunization managers and 59 traditional and religious leaders were engaged. Four broad themes implicating user and provider factors emerged from the 18 focus group discussions as responsible for low immunization uptake in the communities. Of the 217 caregivers trained on routine immunization and theater performances, 72% demonstrated a knowledge increase at the post-test. A total of 29 performances attended by 2,258 women were staged with 84.2% of the attendees feeling satisfied. At the performances, 270 children received vaccine shots (23% were zero-dose). There was a 38% increase in the proportion of fully immunized children in the communities and 9% decline in the proportion of zero-dose children from baseline. CONCLUSION: Both demand- and supply-side factors were identified as responsible for poor vaccination in the intervention communities. Our intervention demonstrates that caregivers will demand immunization services if they are engaged through community theater using a human-centered design (HCD). We recommend a scaling up of HCD to address the challenge of vaccine hesitancy.

A national survey of hospital readiness during the COVID-19 pandemic in Nigeria.

INTRODUCTION: The COVID-19 pandemic continues to overwhelm health systems across the globe. We aimed to assess the readiness of hospitals in Nigeria to respond to the COVID-19 outbreak. METHOD: Between April and October 2020, hospital representatives completed a modified World Health Organisation (WHO) COVID-19 hospital readiness checklist consisting of 13 components and 124 indicators. Readiness scores were classified as adequate (score ≥80%), moderate (score 50-79.9%) and not ready (score <50%). RESULTS: Among 20 (17 tertiary and three secondary) hospitals from all six geopolitical zones of Nigeria, readiness score ranged from 28.2% to 88.7% (median 68.4%), and only three (15%) hospitals had adequate readiness. There was a median of 15 isolation beds, four ICU beds and four ventilators per hospital, but over 45% of hospitals established isolation facilities and procured ventilators after the onset of COVID-19. Of the 13 readiness components, the lowest readiness scores were reported for surge capacity (61.1%), human resources (59.1%), staff welfare (50%) and availability of critical items (47.7%). CONCLUSION: Most hospitals in Nigeria were not adequately prepared to respond to the COVID-19 outbreak. Current efforts to strengthen hospital preparedness should prioritize challenges related to surge capacity, critical care for COVID-19 patients, and staff welfare and protection.

Predictors of antibiotic prescriptions: a knowledge, attitude and practice survey among physicians in tertiary hospitals in Nigeria.

BACKGROUND: As part of the Global Action Plan against antimicrobial resistance (AMR), countries are required to generate local evidence to inform context-specific implementation of national action plans against AMR (NAPAR). We aimed to evaluate the knowledge, attitude, and practice (KAP) regarding antibiotic prescriptions (APR) and AMR among physicians in tertiary hospitals in Nigeria, and to determine predictors of KAP of APR and AMR. METHODS: In this cross-sectional study, we enrolled physicians practicing in tertiary hospitals from all six geopolitical zones of Nigeria. Implementation of an antimicrobial stewardship programmes (ASP) by each selected hospital were assessed using a 12 item ASP checklist. We used a structured self-administered questionnaire to assess the KAP of APR and AMR. Frequency of prescriptions of 18 different antibiotics in the prior 6 months was assessed using a Likert's scale. KAP and prescription (Pr) scores were classified as good (score ≥ 80%) or average/poor (score < 80%). Independent predictors of good knowledge, attitude, and practice (KAPPr) were ascertained using an unconditional logistic regression model. RESULTS: A total of 1324 physicians out of 1778 (74% response rate) practicing in 12 tertiary hospitals in 11 states across all six geopolitical zones participated in the study. None of the participating hospitals had a formal ASP programme and majority did not implement antimicrobial stewardship strategies. The median KAPPr scores were 71.1%, 77%, 75% and 53.3%, for the knowledge, attitude, practice, and prescription components, respectively. Only 22.3%, 40.3%, 31.6% and 31.7% of study respondents had good KAPPr, respectively. All respondents had prescribed one or more antibiotics in the prior 6 months, mostly Amoxicillin-clavulanate (98%), fluoroquinolones (97%), and ceftriaxone (96.8%). About 68% of respondents had prescribed antibiotics from the World Health Organization reserve group. Prior AMR training, professional rank, department, and hospital of practice were independently associated with good KAPPr. CONCLUSIONS: Our study suggests gaps in knowledge and attitude of APR and AMR with inappropriate prescriptions of antibiotics among physicians practicing in tertiary hospitals in Nigeria. Nigeria's NAPAR should also target establishment and improvement of ASP in hospitals and address institutional, educational, and professional factors that may influence emergence of AMR in Nigeria.

Preparation and Response to the 2014 Ebola Virus Disease Epidemic in Nigeria-The Experience of a Tertiary Hospital in Nigeria.

INTRODUCTION: The 2014 Ebola Virus Disease (EVD) outbreak elicited global attention and challenged health systems around the world, Nigeria inclusive. We hereby report the preparation and response to the outbreak by a tertiary teaching hospital in Bayelsa State, Nigeria. METHOD: Between 4th August and 31st October 2014, we conducted a mixed cross sectional and qualitative study to ascertain the EVD-related fear, myths and misconceptions among healthcare workers (HCWs), and to evaluate the plans, activities and challenges faced by the hospital during the outbreak. Data was collected using a self-administered questionnaire as well as by documented observations during the outbreak. HCWs were asked to rate their fear of EVD from 1 (no fear) to 10 (highest fear). RESULTS: Out of 189 respondents, majority (>75%) reported uncertainty about the myth that EVD can be prevented by drinking salt water or eating Garcinia kola, while 82% of respondents believed that EVD can be prevented by avoiding crowded places. About 40% of respondents expressed fear ratings of EVD of ≥ 7 out of 10. In response to the outbreak, the hospital established an EVD response team, organised EVD-sensitization and training programmes and commenced routine EVD surveillance activities. An EVD-isolation ward was constructed from an existing ward, a field incinerator was designed, hand sanitizers were produced locally and personal protective equipment were procured. No case of EVD was reported in the hospital, although three false alarms caused panic. Some HCWs adopted overly protective and avoidance behaviours, but these behaviours were abandoned after the outbreak was declared over. CONCLUSION: Our results suggest that the fear, myth and misconceptions were common among HCW during the outbreak. The EVD outbreak, however, helped to strengthen gaps in infection control and emergency preparedness in the hospital. Strategies to allay fear are required to contain future outbreaks of EVD in Nigeria hospitals.

Determinants of smoking initiation and susceptibility to future smoking among school-going adolescents in Lagos State, Nigeria.

BACKGROUND: It is projected that low and middle-income countries will bear a major burden of tobacco related morbidity and mortality, yet, only limited information is available on the determinants of smoking initiation among youth in Africa. This study aimed to assess the determinants of smoking initiation and susceptibility to future smoking among a population of high school school students in Lagos, Nigeria. MATERIALS AND METHODS: Baseline data from an intervention study designed to assess the effect of an anti-smoking awareness program on the knowledge, attitudes and practices of adolescents was analyzed. The survey was carried out in six randomly selected public and private secondary schools in local government areas in Lagos state, Nigeria. A total of 973 students completed self-administered questionnaires on smoking initiation, health related knowledge and attitudes towards smoking, susceptibility to future smoking and other factors associated with smoking. RESULTS: Of the respondents, 9.7% had initiated smoking tobacco products with the predominant form being cigarettes (7.3%). Males (OR: 2.77, 95%CI: 1.65-4.66) and those with more pro-smoking attitudes (OR: 1.44, 95%CI: 1.34-1.54) were more likely to have initiated smoking. Those with parents and friends who are smokers were 3.47 (95%CI: 1.50-8.05) and 2.26 (95%CI: 1.27-4.01) times more likely to have initiated smoking. Non-smoking students, in privately owned schools (OR: 5.08), with friends who smoke (5.09), with lower knowledge (OR: 0.87) and more pro-smoking attitudes (OR 1.13) were more susceptible to future smoking. In addition, respondents who had been sent to purchase cigarettes by an older adult (OR: 3.68) were also more susceptible to future smoking. CONCLUSIONS: Being male and having parents who smoke are predictors of smoking initiation among these students. Consistent with findings in other countries, peers not only influence smoking initiation but also influence smoking susceptibility among youth in this African setting. Prevention programs designed to reduce tobacco use among in-school youth should take these factors into consideration. In line with the recommendations of article 16 of the WHO FCTC, efforts to enforce the ban on the sales of cigarettes to minors should be also emphasised.