Neutralizing anti-polio antibody titre in newborn babies in post-polio eradication period in Nigeria.

BACKGROUND: According to Polio Eradication and Endgame Strategic Plan 2019-2023 (PEESP), countries that achieved wild polio elimination is expected to replace oral polio vaccine (OPV) which has a risk of vaccine-derived poliovirus, Inactivated Polio Vaccine (IPV). It is important to determine the earliest time in the age of a child at which IPV could be introduced into the country's routine immunization schedule for effectiveness especially as it concerns neutralizing effect of trans-placental transmitted antibodies which usually does not affect OPV. In this study, the level of poliovirus neutralizing antibody titre among neonates at birth was evaluated. METHODS: A cross-sectional study of mother-baby pair. The serum level of the neutralizing Poliovirus antibody IgG titre was done by the Enzyme Linked Immunosorbent Assay (ELISA) technique. RESULTS: There was 100% transfer of maternal passive antibodies to their babies. The mean poliovirus antibody titre among neonates was 21.8 IU/L which was above the neutralizing titre level. Most (85.7%) babies antibody level correlate positively with that of their mothers. CONCLUSION: The transferred maternal antibodies to the babies are still very high at birth, and capable of dampening the immunity of IPV if introduced early. Programme managers should evaluate the impact and benefit of given booster dose of IPV to pregnant mothers to increase the titre level in their babies. This will be very necessary when the OPV is withdrawn from the immunization schedule.

Burden of childhood and adolescence asthma in Nigeria: Disability adjusted life years.

BACKGROUND: A better representation of the burden of childhood asthma should rely on both morbidity and mortality and not only mortality. This will reduce the dearth of information on burden of childhood asthma, and enhance evidence-based decision-making. In this study, burden of childhood asthma was estimated, using disability-adjusted-life-years (DALYs), factoring in the disability weights for asthma, age at mortality and life expectancy. METHODS: The study was conducted at the University of Nigeria Teaching Hospital, Enugu. An Interviewer Administered Questionnaire was used to collect information from parents of children with asthma who presented to respiratory clinics regarding level of their asthma control (controlled, partially controlled and poorly controlled asthma), their age distributions, and gender. The prevalence of asthma, prevalence of associated disability, and case-fatality were obtained from previous publications. The DALYs were estimated by adding together the years lost to disability (YLDs) and years lost to life (YLLs) to asthma (DALYs = YLD + YLL). DALYs were dis-aggregated by age group and by whether their asthma were controlled, partially controlled and poorly controlled. RESULTS: A total of 66 children with asthma were studied. The proportion of the subjects with controlled, partially controlled and poorly controlled asthma were 26 (39.4%), 31 (47%), and 9 (13.6%) respectively. The subjects that had some form of asthma-related disability were 16 (24.3%). Childhood asthma caused 23.6-34.24 YLLs per 1000 population, 0.01-1.28 YLDs per 1000 population and 24.23-34.41 DALY per 1000 population. There was minimal difference in DALYs across the three clinical categories, but this was consistently higher among older children 12-17 years. The estimated national DALYs was 407820.2, reflecting about of 1.6% of the global all age (children and adults) DALYs of 24.8 million. CONCLUSION: The DALYs due to childhood asthma were high and did not vary much across the clinical categories, but increased with age. This imperatively necessitates the de-emphasis on just clinical responses as an indicator of the efficiency of childhood asthma control interventions but rather a holistic approach should be adopted considering the limitations the child suffers as a component of both life and environmental modification in a deliberate attempt to prevent attacks. The ability of the child to function optimally while on treatment should be considered in the treatment impact review.

Economic burden of childhood asthma in children attending a follow-up clinic in a resource-poor setting of Southeast Nigeria.

BACKGROUND: Beyond its chronicity, childhood asthma carries an economic burden for households. In this study we evaluated the cost of care of childhood asthma in a Nigerian household. METHODS: A cross-sectional hospital-based study. Relevant information was obtained through an interviewer-administered questionnaire. The cost of asthma treatment was estimated using direct medical costs and loss in productivity. Data analysis was done with SPSS version 22. A significant value of p < 0.05 was used. RESULTS: Sixty-six participants were enrolled, mean ±â€¯SD age (11.6 ±â€¯) the average direct cost was USD10.35. The cost of drug was USD5.8 and accounted for 56% of the direct cost. The loss in productivity was USD16.73. The mean cost per clinic visit was USD27.08, which was catastrophic in 12 (18.2%) households. The calculated annual cost of asthma treatment was USD162.49, with a cumulative national cost of USD 0.16 billion, which makes up 0.002% of the national GDP. CONCLUSION: The cost burden of asthma treatment may be low on the households but carries a huge national cost impact. We recommend the inclusion of asthma care in the Nigerian social health insurance as this may help reduce the financial burden due to asthma.

Achieving financial risk protection through a national Social Health Insurance Programme in Nigeria: Perspectives of enrollees and healthcare providers.

INTRODUCTION: Out-of-pocket (OOP) payment adversely affects universal financial risk protection (UFRP) and the achievement of Universal Health Coverage (UHC). Since the introduction of a Formal Sector Social Health Insurance Programme (FSSHIP) in Nigeria, the extent to which it has provided UFRP is still largely unknown. This study therefore assessed this from the perspectives of both enrollees and healthcare providers. METHODS: The study was undertaken in Enugu state, Nigeria. The subjects were randomly selected primary enrollees and health care providers. An interviewer-administered questionnaire was used for data collection on service utilization under the FSSHIP, as well as out-of-pocket payment of healthcare expenditure. RESULTS: Out of 333 formal sector workers interviewed, 283 (85%) were registered in the FSSHIP and 61.1% of them utilized FSSHIP. Among these, 89.8% of them used OOP to pay for about 95.2% of the healthcare expenditure. From the perspectives of the providers, 97.6%, patients still paid using OOP. CONCLUSION: The FSSHIP is not providing UFRP as expected. This weakens the effectiveness of the FSSHIP to ensure UFRP and ultimately UHC. The NHIS should modify the FSSHIP to provide UFRP and eliminate both the high level of OOP and the proportion of expenditure it covers.

Health-Care Workers' Perspectives on Preparedness of Health-Care Facilities for Outbreak of Communicable Diseases in Nigeria: A Qualitative Study.

A high probability of another outbreak of communicable disease exists in sub-Saharan African countries, after the Ebola virus disease outbreak of 2014. Thus, health-care facility (HCF) preparedness for a prompt and effective response to disease outbreaks needs to be ascertained. In this study, Nigerian health-care workers' (HCWs) knowledge of preparedness, perception of the level of preparedness existing in these HCFs, militating factors, and possible ways to improve, were evaluated through qualitative data collection, using focus group discussion and in-depth interview. Among the 193 HCWs which participated in the study, the perception of 190 (98.4%) was that their HCFs were insufficiently equipped to respond to disease outbreaks. None of the facilities had an emergency operation unit (EOU). Most HCWs perceived preparedness as observation of universal precautions. Other aspects of preparedness, such as training, routine emergency drills, disease surveillance, waste management, and design and location of HCFs were minimally mentioned. None of the participants had undergone any form of emergency drill training. Among the suggestions of how to improve on preparedness were immunization of staff, improved inter-departmental communication within the HCF, and routine training. The overall poor level of preparedness which exists in the HCFs means that they cannot prevent or contain a communicable disease outbreak. There is a need to improve universal precautions, communication within the HCFs, and routine interpretation of surveillance data by epidemiologists. There is also a need for the establishment of EOU in every HCF, a system that responds to, and manages emergency response to disease outbreaks, which also must be functional during non-outbreak periods.

Profile of chronic kidney disease modifiable risk factors in a rural community of south east Nigeria.

BACKGROUND: Chronic kidney disease (CKD) is on the increase globally. Prevention of this condition is ideal, however early detection of the disease becomes desirable where the disease process has begun as there are known interventions which can slow the progress to end stage renal disease (ESRD). This study aimed at detecting the profile of some modifiable risk factors for CKD in a cohort of household heads in a rural community with limited resources for managing chronic kidney diseases. METHODS: The study was conducted in a rural community in southeast Nigeria. One hundred and forty five household heads from randomly selected households were interviewed. Their blood pressures were taken and their urine tested. The data was analyzed using SPSS version 21. Simple frequencies and means were calculated. RESULTS: A total of 145 house hold heads were enrolled. Their mean age was 45.08 (19.65) years. Forty-seven percent had no prior knowledge of their blood pressure and 31.5% were found to be hypertensive. Only one study participant (1%) had ever had a urinalysis test and proteinuria and glycosuria were found in 50.4 and 27.9% respectively. Most (75%) patronized patent medicine vendors for their primary healthcare while 31.8% had taken herbal mixtures in the past. CONCLUSION: There are presently many modifiable risk factors for the development of chronic kidney disease in rural communities in south-east Nigeria. Urgent targeted intervention is required to forestall an epidemic of CKD in the near future.

Setting a Nigeria national malaria operational research agenda: the process.

BACKGROUND: Employing malaria operational research (MOR) findings in planning national malaria control programmes is gaining increased attention. The malaria control foci are diverse, resources are limited; therefore, agreeing on priority areas is critical. Hitherto, the process of prioritising MOR questions in Nigeria has been limited to few stakeholders. In support of the National Malaria Elimination Programme's (NMEP) effort at setting a MOR agenda, the Nigeria Field Epidemiology and Laboratory Training Programme (NFELTP) in collaboration with NMEP conducted preliminary exploratory study to identify key malaria research gaps and needs, and provide data to inform setting a robust national MOR agenda. The process of generating data is presented in this paper. METHODS: A twelve-member task-team comprising NFELTP, university researchers and NMEP officers was commissioned. Following an inaugural meeting the task-team developed a framework of activities and held five planning meetings, conducted five-week online and self-administered paper-based surveys, key informant interview (KII), two-day desk review workshop, seven-day qualitative data analysis, ten-day result and five-day report writing workshops. Paired group members conducted the interviews across six geopolitical zones of Nigeria. Abridged study report was used for a two-day MOR setting agenda stakeholders' workshop. RESULTS: A structured framework, study protocol and data collection instruments were developed and submitted for ethical approval. The instruments included survey questionnaire for detailed information on researchers and other stakeholders' experience with MOR, the gaps and needs in thematic MOR areas; KII and Delphi guides. After an initial scoping review, primary data were collected from purposively selected survey participants using mixed methods: - online survey (n = 100), self-administered paper-based survey (n = 85), KII (n = 40), desk review workshop (n = 22) and Delphi interviews (n = 8). Comprehensive lists of research gaps/bottlenecks and needs were generated for each thematic area in malaria control. These were used at a two-day national MOR setting stakeholder workshop (n = 54) to guide the development of national MOR agenda document. CONCLUSIONS: A systematic approach involving broad stakeholder engagement provided data and evidence-based information for development of a robust national MOR agenda. The processes involved are recommended for use in malaria endemic settings.

Bottlenecks, concerns and needs in malaria operational research: the perspectives of key stakeholders in Nigeria.

OBJECTIVE: We conducted a study to determine stakeholders' perspective of the bottlenecks, concerns and needs to malaria operational research (MOR) agenda setting in Nigeria. RESULTS: Eighty-five (37.9%) stakeholders identified lack of positive behavioural change as the major bottleneck to MOR across the malaria thematic areas comprising of malaria prevention 58.8% (50), case management 34.8% (39), advocacy communication and social mobilisation 4.7% (4) while procurement and supply chain management (PSM) and programme management experts had the least response of 1.2% (1) each. Other bottlenecks were inadequate capacity to implement (13.8%, n = 31), inadequate funds (11.6%, n = 26), poor supply management (9.4%, n = 21), administrative bureaucracy (5.8%, n = 13), inadequacy of experts (1.3%, n = 3) and poor policy implementation (4.9%, n = 11). Of the 31 stakeholders who opined lack of capacity to execute malaria operational research; 17 (54.8%), 10 (32.3%), 3 (9.7%) and 1 (3.2%) were experts in case management, malaria prevention, surveillance, monitoring and evaluation and PSM respectively. Improvement in community enlightenment and awareness strategies; and active involvement of health care workers public and private sectors were identified solutions to lack of positive behavioural change.

A qualitative exploration of malaria operational research situation in Nigeria.

BACKGROUND: Malaria, remains one of the leading causes of high morbidity and mortality in Nigeria despite implementation of several public health interventions for its control. Operational limitations and methodological gaps have been associated with malaria control interventions and research, and these have necessitated the need for a well-tailored Malaria Operational Research (MOR) agenda. However, there is paucity of evidence-based information on relevant stakeholders' experience, awareness, perceptions and use of MOR and suggestions on setting MOR agenda. As part of a larger study to provide data for national MOR agenda setting, we assessed the MOR research situation from the perspectives of key stakeholders in Nigeria and contribution of MOR to the malaria elimination agenda. METHODS: We conducted key informant interviews among 40 purposively selected stakeholders from the six geo-political zones in Nigeria. Data was collected using a pre-tested key informant interview guide which comprised issues related to experience, awareness, use of MOR and MOR needs, and suggestions for MOR. We conducted a detailed content analysis. RESULTS: Half of the participants had participated in MOR. Participants perceived MOR as important. Only few were aware of existing framework for MOR in Nigeria while above half expressed that MOR is yet to be used to inform policy in Nigeria. Participants identified several MOR needs such as development of improved diagnostic techniques, and interventions for promoting early diagnosis, prompt treatment and quality programmatic data. Participants opined the need for country-specific prioritised MOR agenda that cut across malaria thematic areas including malaria prevention and case management. Participants suggested the involvement of various stakeholders and multi-disciplinary approach in setting MOR. CONCLUSION: Although some stakeholders have been involved in MOR, it is still rarely used to inform policy and several needs exist across thematic areas. A broad-based stakeholder involvement, multi-disciplinary approach to agenda setting and its wide dissemination have been suggested.

Health-Care Workers' Perspectives on Ebola Virus Vaccine: A Focus Group and In-Depth Interview Interventional Study.

Health-care workers (HCWs) will require Ebola virus vaccine (EVV) when it is introduced because of the high risk of exposure to the disease. Evaluations of factors that facilitate or limit vaccine uptake are critical for a successful vaccine program. Nigerian HCWs were interviewed to evaluate their knowledge, levels of acceptance, determinants of acceptance, and willingness to pay for EVV. The significance level was set at P ≤ 0.05. None of the 193 participating HCWs had correct knowledge of EVV; 34.7% (67/193) of workers thought that EVV was an extract of the serum of Ebola virus patients. About 77.3% (51/66) of workers in a region that reported Ebola cases (Lagos) were willing to be vaccinated, compared with 4.7% (3/61) in Enugu and 13.6% (9/66) in Abia (P = 0.0001). After health education, the proportion of HCWs willing to receive EVV increased (P = 0.006) except for doctors (P < 0.1). The percentage of HCWs willing to pay for EVV was 86.4%, 72.1%, and 59% in Lagos, Enugu, and Abia, respectively. The workers had fears about EVV based on nonfactual assumptions. Therefore, the EVV introduction strategy should include a strong awareness campaign with adequate explanation about the content of EVV.

Determining the disability adjusted life years lost to childhood and adolescence epilepsy in southeast Nigeria: An exploratory study.

OBJECTIVES: Disease burden has always been based on associated mortality. An accurate measurement of the burden of epilepsy should rely on both morbidity and mortality. This will close any existing gap in knowledge and provide useful information to aid evidence-based decision-making. In this study, burden of epilepsy was estimated, using disability-adjusted-life-years (DALYs), using disability weights for epilepsy that were part of the Global Burden of Disease 2010 work. METHODS: The study was conducted at the University of Nigeria Teaching Hospital, Enugu. Interviewer-administered questionnaire was used to collect information from patients with epilepsy who presented to neurology clinic. The prevalence of epilepsy, and case-fatality were obtained from previous publications. The DALYs were estimated by adding together the years lost to disability (YLDs) and years lost to life (YLLs) to epilepsy (DALYs=YLD+YLL). DALYs were dis-aggregated by age group and by whether or not epilepsy was treated. RESULTS: A total of 134 children with epilepsy-interviews were conducted. Some 56% and 44% of the subjects had primary and secondary epilepsy, respectively. The childhood epilepsy caused 1.63 YLLs per 1000 population, 0.45 YLDs per 1000 population and 2.08 DALY per 1000 population. The highest burden was in children within the age group of 5-14 years at 2.18 DALY per 1000 people. The YLDs was higher (0.63/1000 population) among the untreated group, compared with the YLDs (0.27/1000 population) among the treated group. The YLLs lost for children with secondary epilepsy (2.23/1000 population) was higher than primary epilepsy YLLs of 1.07/1000 population. SIGNIFICANCE: The DALYs due to childhood epilepsy was high. The YLDs was high among children with epilepsy who were not on treatment. The YLLs were found to be the same in all children with epilepsy, irrespective of their treatment status. This imperatively necessitates the de-emphasis on just mortality as an indicator of the burden of childhood epilepsy but rather a holistic approach should be adopted in considering both the mortality and disability in monitoring the outcome of health interventions.

Economic cost of treatment of childhood epilepsy in Enugu, southeast Nigeria.

OBJECTIVES: The aim of this study was to determine the economic costs and the level of catastrophic health expenditure (CHE) due to childhood epilepsy. METHODS: The study was conducted at the Paediatric Neurology Clinic of the University of Nigeria Teaching Hospital, Enugu. Data were collected using pre-tested questionnaires that were administered to caregivers of the children. The indirect and direct expenditure due to childhood epilepsy were computed. A 40 percent of monthly non-food expenditure was used to estimate CHE. RESULTS: The average annual direct and indirect expenditures were USD 162.6 and USD 82.3, respectively. Most of direct costs were drugs (25.4 percent versus 35.3 percent) and investigations (48.7 percent versus 61.3 percent) for out-patient and in-patient, respectively. CHE was 34.1 percent and 63.6 percent for out-patient and in-patient care, respectively. The total annual costs: (direct and indirect), for childhood epilepsy of USD244.9. Considering the estimated 190,000 epileptic children in Nigeria, it will amount to USD46.53 million annually, approximately 0.018 percent of Nigeria Gross Domestic Product (GDP). All payments were made out-of-pocket with no health insurance for financial risk protection. CONCLUSIONS: The cost of treatment of childhood epilepsy is high and catastrophic for many households. There was lack of usage of health financial risk mechanisms. Scale-up use of health financial risk protection mechanisms such as health insurance can reduce the economic burden.

Qualitative study of presumptive treatment of childhood malaria in third tier tertiary hospitals in southeast Nigeria: a focus group and in-depth study.

BACKGROUND: Presumptive treatment of childhood-malaria (PTCM) is common in Nigeria. Delayed laboratory result is blamed, with little attention on patients' and providers' roles. This study aimed to determine patient, provider and laboratory attributes that sustain PTCM in Nigeria. METHODS: Data collection was from focus-group discussions for parents/guardians, and in-depth interviews involving providers and laboratory scientists in two tertiary hospitals. RESULTS: All parents/guardians agreed to a malaria test. Majority accepted to come back later for full treatment, provided that some treatment was commenced. Majority affirmed that their interests are on their children's improvement.The providers practice presumptive treatment of childhood malaria, for the following reasons: (1) malaria is endemic and should be suspected and treated; (2) microscopy takes two days to be available and parents want immediate treatment for their children, thus delay may lead to self-medication; (3) relying on results for decision to treat creates an impression of incompetence; (4) rapid diagnostic test kits (RDTs) are not available in the consulting rooms and there is doubt about their reliability; (5) patients have already wasted time before being reviewed, so wasting more time on investigation is not advisable; (6) withhold of malaria treatment may be feasible in suspected uncomplicated malaria, but if severe, then anti-malarial treatment has to start immediately.Interviews of laboratory scientists showed that (1) malaria microscopy test cannot be urgent; it is done in batches and takes 24 hours to be ready; (2) a request of malaria test with other investigations on the same form, contributes to the delay; (3) RDTs are unavailable in the facilities. CONCLUSIONS: Provision of RDTs is the only feasible means to treatment of confirmed malaria at the time healthcare providers review a patient on day zero. In facilities that depend on microscopy; a common practice in resource poor countries, healthcare providers can depend on parental willingness to return later for full medication, to commence adjunctive care with antipyretics and multivitamins for uncomplicated malaria. In complicated malaria, supportive care - intravenous fluids, blood transfusion, oxygen therapy - can be commenced while awaiting the inclusion of anti-malarial drugs when the diagnosis of malaria is confirmed.

Willingness to pay for rapid diagnostic tests for the diagnosis and treatment of malaria in southeast Nigeria: ex post and ex ante.

BACKGROUND: The introduction of rapid diagnostic tests (RDTs) has improved the diagnosis and treatment of malaria. However, any successful control of malaria will depend on socio-economic factors that influence its management in the community. Willingness to pay (WTP) is important because consumer responses to prices will influence utilization of services and revenues collected. Also the consumer's attitude can influence monetary valuation with respect to different conditions ex post and ex ante. METHODS: WTP for RDT for Malaria was assessed by the contingent valuation method using a bidding game approach in rural and urban communities in southeast Nigeria. The ex post WTP was assessed at the health centers on 618 patients immediately following diagnosis of malaria with RDT and the ex ante WTP was assessed by household interviews on 1020 householders with a prior history of malaria. RESULTS: For the ex ante WTP, 51% of the respondents in urban and 24.7% in rural areas were willing to pay for RDT. The mean WTP (235.49 naira) in urban is higher than WTP (182.05 Naira) in rural areas. For the ex post WTP, 89 and 90.7% of the respondents in urban and rural areas respectively were WTP. The mean WTP (372.30 naira) in urban is also higher than (296.28 naira) in rural areas. For the ex post scenario, the lower two Social Economic Status (SES) quartiles were more willing to pay and the mean WTP is higher than the higher two SES while in the ex ante scenario, the higher two SES quartiles were more WTP and with a higher WTP than the lower two SES quartile. Ex ante and ex post WTP were directly dependent on costs. CONCLUSION: The ex post WTP is higher than the ex ante WTP and both are greater than the current cost of RDTs. Urban dwellers were more willing to pay than the rural dwellers. The mean WTP should be considered when designing suitable financial strategies for making RDTs available to communities.

Rural-urban differences in maternal responses to childhood fever in South East Nigeria.

BACKGROUND: Childhood fevers due to malaria remain a major cause of morbidity and mortality among under-five children in Nigeria. The degree of vulnerability perceived by mothers will affect their perception of the severity and threat of their child's fever and the patterns of health care use. This study was undertaken to compare maternal responses to childhood fever in urban and rural areas of Enugu, south east Nigeria. METHODOLOGY/PRINCIPAL FINDINGS: Data was collected with pre-tested interviewer-administered questionnaires from 276 and 124 urban and rural households respectively. In each household, only one woman aged 15-49 years who had lived in each of the urban and rural communities for at least one year and had at least one child less than 5 years old was interviewed. Malaria was mentioned as the commonest cause of childhood fevers. Rural mothers were more likely to recognize danger signs and symptoms than urban mothers. Rural mothers use more of informal than formal health services, and there is more home management of the fever with urban than rural mothers. Chloroquine, ACT, SP and Paracetamol are the main drugs given at home for childhood fevers, but the rural mothers were more likely to use leftover drugs from previous treatment to treat the fevers than urban mothers. The urban respondents were also more likely to use a preventive measure. Urban mothers sought actions faster than rural mothers and the total cost of treatment was also higher in urban areas. CONCLUSIONS/SIGNIFICANCE: Both urban and rural mothers are aware that malaria is the major cause of childhood fevers. Although rural mothers recognize childhood fever and danger signs better than urban mothers, the urban mothers' responses to fever seem to be better than that for rural mothers. These responses and differences may be important for geographical targeting by policy makers for malaria interventions.