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.

A Multi-Site Knowledge Attitude and Practice Survey of Ebola Virus Disease in Nigeria.

BACKGROUND: The 2014 Ebola Virus Disease (EVD) outbreak was characterised by fear, misconceptions and irrational behaviours. We conducted a knowledge attitude and practice survey of EVD in Nigeria to inform implementation of effective control measures. METHODS: Between July 30th and September 30th 2014, we undertook a cross sectional study on knowledge, attitude and practice (KAP) of Ebola Virus Disease (EVD) among adults of the general population and healthcare workers (HCW) in three states of Nigeria, namely Bayelsa, Cross River and Kano states. Demographic information and data on KAP were obtained using a self-administered standardized questionnaire. The percentage KAP scores were categorised as good and poor. Independent predictors of good knowledge of EVD were ascertained using a binary logistic regression model. RESULTS: Out of 1035 study participants with median age of 32 years, 648 (62.6%) were males, 846 (81.7%) had tertiary education and 441 (42.6%) were HCW. There were 218, 239 and 578 respondents from Bayelsa, Cross River and Kano states respectively. The overall median percentage KAP scores and interquartile ranges (IQR) were 79.46% (15.07%), 95.0% (33.33%) and 49.95% (37.50%) respectively. Out of the 1035 respondents, 470 (45.4%), 544(52.56%) and 252 (24.35%) had good KAP of EVD defined using 80%, 90% and 70% score cut-offs respectively. Independent predictors of good knowledge of EVD were being a HCW (Odds Ratio-OR-2.89, 95% Confidence interval-CI of 1.41-5.90), reporting 'moderate to high fear of EVD' (OR-2.15, 95% CI-(1.47-3.13) and 'willingness to modify habit' (OR-1.68, 95% CI-1.23-2.30). CONCLUSION: Our results reveal suboptimal EVD-related knowledge, attitude and practice among adults in Nigeria. To effectively control future outbreaks of EVD in Nigeria, there is a need to implement public sensitization programmes that improve understanding of EVD and address EVD-related myths and misconceptions, especially among the general population.

Prevalence of hypertension and its correlates among employees of a tertiary hospital in Yenagoa, Nigeria.

BACKGROUND: Hypertension (HTN) is a common medical problem with increasing prevalence and dire consequences. Considering the relative proximity of hospital workers to health care delivery, one may expect a better control of HTN and associated risk factors in this population. The objective of the current study was to determine the prevalence of HTN and risk factors among hospital employees in a Nigerian tertiary hospital. MATERIALS AND METHODS: All employees of the Federal Medical Center, Yenagoa (Bayelsa State, Nigeria) were invited for a HTN screening exercise on the world kidney day on March 14, 2013. A total of 231 participants completed this cross-sectional study. Data was obtained with a pre-tested interviewer-administered structured questionnaire while blood pressure was taken with an Accoson sphygmomanometer. Anthropometry was done using standardized protocols. Urine and blood were analyzed for glucose. HTN was defined as blood pressure >140/90 or prior diagnosis or use of antihypertensives. Data was entered, stored and analyzed with Statistical Package for Social Sciences (SPSS Inc., Chicago, IL, USA) version 20. RESULTS: The crude and age-adjusted prevalence of HTN among the hospital employee was 21.3% and 23.8% respectively. Age, marital status, educational level, body mass index, waist circumference (WC) and waist hip ratio showed significant association with HTN in the univariate analysis. However, in multivariate regression analysis, only older age and abnormal WC predicted HTN. CONCLUSION: The prevalence of HTN among the hospital employees compared with reports in other population and was predicted by advancing age and abnormal WC. The study underscores the need for introduction of HTN screening programs among hospital employees especially staff that are older with truncal obesity.