Evaluation of malaria surveillance system in Benue State, Nigeria.

BACKGROUND: Malaria is a priority global health disease with high morbidity and mortality especially among children under-five and pregnant women. Malaria elimination requires an effective surveillance system. The malaria surveillance system in Benue State was evaluated to assess its attributes and performance in line with set objectives. METHODS: The updated United States Centers for Disease Control and Prevention guideline for evaluating surveillance systems was used. The surveillance system's key attributes was quantitatively and qualitatively assessed. Semi-structured questionnaires were administered to all Local Government Area (LGA) Roll Back Malaria (RBM) focal persons and five key informants were interviewed at the State level. The Benue State District Health Information System-2 (DHIS-2) malaria data and monthly summary forms were reviewed from January 2015 to December 2019. RESULTS: A total of 46 RBM focal persons and 5 key-informants participated. About 56.9% were males, the mean-age 43.8 (SD ± 9.3) years and 32 (62.8%) had ≥ 20-year experience on malaria surveillance with mean-year-experience 20.8 (SD ± 7.8) years. All 46 (100%) RBMs understood the case definition; 43 (93.5%) found it easy-to-fill the standardized data tools and understood the data flow channels. The malaria surveillance system in Benue is simple, acceptable and useful to all stakeholders, 36 (70.6%) found switching from the paper-based to the electronic-data tools with ease and 45 (88.2%) stated that analysed data were used for decision-making. Data flow from LGA to State is clearly defined, however majority of the data is collected from public health facilities through the DHIS-2 Platform. The overall timeliness and completeness of reporting was 76.5% and 95.7%, respectively, which were below the ≥ 80% and 100% targets, respectively. CONCLUSIONS: The malaria surveillance system in Benue State is simple, useful, acceptable, and flexible, but it is not representative and timely. Public-private and public-public-partnerships should be strengthened to encourage reporting from both private and tertiary health facilities and improve representativeness, and frequent feedback to improve reporting timeliness.

Bat and Lyssavirus Exposure among Humans in Area that Celebrates Bat Festival, Nigeria, 2010 and 2013.

Using questionnaires and serologic testing, we evaluated bat and lyssavirus exposure among persons in an area of Nigeria that celebrates a bat festival. Bats from festival caves underwent serologic testing for phylogroup II lyssaviruses (Lagos bat virus, Shimoni bat virus, Mokola virus). The enrolled households consisted of 2,112 persons, among whom 213 (10%) were reported to have ever had bat contact (having touched a bat, having been bitten by a bat, or having been scratched by a bat) and 52 (2%) to have ever been bitten by a bat. Of 203 participants with bat contact, 3 (1%) had received rabies vaccination. No participant had neutralizing antibodies to phylogroup II lyssaviruses, but >50% of bats had neutralizing antibodies to these lyssaviruses. Even though we found no evidence of phylogroup II lyssavirus exposure among humans, persons interacting with bats in the area could benefit from practicing bat-related health precautions.

Occupational exposure to HIV among healthcare workers in PMTCT sites in Port Harcourt, Nigeria.

BACKGROUND: Rivers State is among the states with high HIV prevalence in Nigeria. Occupational exposure to HIV through blood or body fluids of HIV/AIDS patients is a recognised risk factor of HIV infections among healthcare workers. We identified the determinants of occupational exposures to HIV among healthcare workers in Prevention of Maternal to Child Transmission (PMTCT) sites within Port Harcourt metropolis in Rivers State. METHODS: A descriptive cross-sectional study was conducted and multi-stage sampling technique was used to select 341 healthcare providers from 22 public and 22 private health facilities in PMTCT sites in Port Harcourt metropolis. The data collected were analysed using descriptive statistics, Chi-square and logistic regression models (p-value = 0.05). RESULTS: Respondents' mean age was 35.9 ± SD8.4 years, 270 (80.1%) and 171(50.7%) were females, and from public health facilities respectively. Prevalence of occupational exposure of healthcare workers to HIV in the past 12 months was 153 (45.0%), and 96 (63.3%) experienced such exposure more than once. Contacts with potentially infectious body fluid accounted for the largest proportion 51 (33.3%); followed by needle stick prick 49 (32.6%). About 189 (56.1%) had safety information at their disposal and this serves as a reminder on safety precautions. The likelihood of occupational exposure was significantly higher among doctors (AOR = 2.22, 95% C.I = 1.16-4.25,) but lower among environmental health workers (AOR = 0.10, 95% C.I = 0.02-0.46,) than nurses/midwives when other factors were included in the model. CONCLUSION: Occupational exposure to blood and body fluids remains a frequent occurrence among healthcare workers; highest among doctors in PMTCT sites in the study area. Provision of protective safety materials, training and enforcement of adherence to universal precaution strategies are highly recommended.

Immunisation coverage and its determinants among children aged 12-23 months in Atakumosa-west district, Osun State Nigeria: a cross-sectional study.

BACKGROUND: Routine immunisation (RI) contributes immensely to reduction in mortality from vaccine preventable diseases (VPD) among children. The Nigerian Demographic and Health Survey, 2008 revealed that only 58 % of children in Osun State had received all recommended vaccines, which is far below World Health Organization (WHO) target of 80 %. We therefore, assessed RI uptake and its determinants among children in Atakumosa-west district of Osun State. METHODS: Atakumosa-west district has an estimated population of 90,525 inhabitants. We enrolled 750 mothers of children aged 12-23 months in this cross-sectional study. Semi-structured questionnaires were used to obtain data on socio-demographic characteristics, knowledge of mothers on RI, history of RI in children and factors associated with full RI uptake. A fully-immunised child was defined as a child who had received one dose of Bacillus-Calmette-Guerin, three doses of Oral-Polio-Vaccine, three doses of Diptheria-Pertusis-Tetanus vaccine and one dose of measles vaccine by 12 months of age. We tested for the association between immunisation uptake and its likely determinants using multivariable logistic regression at 0.05 level of significance and 95 % confidence Interval (CI). RESULTS: Mean ± (SD) age of the mothers and children were 27.9 ± 6.1 years and 17.2 ± 4.0 months, respectively. About 94 % (703/750) of mothers had received antenatal care (ANC) and 63.3 % (475) of the children possessed vaccination cards. Seventy-six percent (571/750) had good knowledge of RI and VPD. About 58 % (275/475) of children who possessed vaccination card were fully-immunised. Mothers antenatal care attendance (aOR = 3.3, 95 % CI = 1.1-8.3), maternal tetanus toxoid immunisation (aOR = 3.2, 95 % CI = 1.1-10.0) access to immunisation information (aOR = 1.8, 95 % CI = 1.1-2.5) and mothers having good knowledge of immunisation (aOR = 2.4, 95 % CI = 1.6-3.8) were significant determinants of full immunisation. CONCLUSIONS: Routine immunisation uptake was still below WHO target in the study area. Encouraging mothers to attend antenatal care and educational interventions targeted at rural mothers are recommended to improve vaccination status of children in the rural communities.

HIV and AIDS-related knowledge, HIV risk perception, uptake of HIV testing and its predictors among prison inmates in Bauchi State, Nigeria: a cross-sectional study.

Introduction: globally, HIV infection among prison inmates is significantly higher than in the general population. Therefore, it is important to identify inmates-living-with-HIV, through HIV-testing, in keeping with the target of UNAIDS vision 90-90-90. We assessed HIV/AIDS-related knowledge, HIV-risk perception and predictors of HIV-testing-uptake in Bauchi Prison. Methods: we conducted a cross-sectional study among 310 inmates selected with 2 stage sampling. Data was collected using a pretested, structured, interviewer-administered questionnaire. Inmates that consented to HIV-test were tested. We estimated inmates' knowledge about HIV/AIDS, the level of HIV testing uptake and predictors of HIV testing-uptake using multiple logistic regression at 5% significant level. Results: the mean age (SD) was 32.3 (±9.4) years and 94.8% were males, 47.1% (95% CI: 41.6-52.7) of the respondents had good knowledge of HIV/AIDS. Fifty-five percent (95% CI: 49.9-60.9) felt they were not at risk of contracting HIV. Uptake of HIV-testing was 58.1% (95% CI: 52.5-63.4). Independent predictors for the uptake of HIV-testing were age 35-44 years (aOR= 3.3; 95% CI: 1.4-7.7), positive risk perception (aOR= 3.3; 95% CI: 1.8-6.2), good knowledge of HIV (aOR= 9.6; CI: 5.1-18.0) and knowing someone who had died of AIDS (aOR= 4.1; 95% CI: 1.9-6.4). Conclusion: good knowledge of HIV/AIDS and HIV-testing-uptake was low among the inmates. We recommended the development and implementation of targeted HIV-testing interventions that cater to the specific needs of different age-groups within the prison population. The prison authority should develop prison-specific health education programme and awareness campaigns aimed at promoting accurate HIV-risk perception, improving their knowledge and help inmates make informed decisions that will prevent them from contracting HIV.

Implementing a robust adverse event of special interest surveillance for novel oral polio vaccine type 2 rollout, Nigeria, March-July 2021.

Introduction: novel oral poliovirus vaccine type 2 (nOPV2), designed to be more genetically stable than Sabin-strain oral poliovirus vaccine type 2 (mOPV2), is a new and key component of the Global Polio Eradication Initiative's strategy to combat outbreaks of circulating vaccine-derived poliovirus type 2 (cVDPV2). The World Health Organization´s (WHO´s) emergency use listing (EUL) requires extensive safety monitoring for Adverse Event of Special Interest (AESI) in its use. We implemented AESI active surveillance to monitor the safety of the nOPV2 in Nigeria. Methods: a cross-sectional assessment was conducted in Nigeria during March-June 2021 in 117 local government areas (LGAs) across 6 states and the Federal Capital Area with confirmed cVDPV2 transmission. We conducted active searches for nOPV2 AESI in all health facilities. Suspected events were ascertained, and vaccination and clinical data abstracted. Events were classified using WHO causality assessment algorithm. Data were analyzed using Epi info7. Results: total of 234 adverse events were reported after 21,997,300 doses of nOPV2 were administered, giving a crude reported incidence of 1 in 94,000 doses of nOPV2. Altogether, 221 of the 234 (94%) adverse events were classified. For 166 AESI ascertained to occur following a dose of nOPV2, the corrected crude incidence rate was 1 in 133,000 doses; 4 of the adverse events, were classified as consistent with casual association with nOPV2 vaccination. Conclusion: we found that nOPV2 had a low incidence of AESI following nOPV2 campaigns and no new or unexpected adverse event was reported. Safety monitoring should be sustained for early detection of signals and uncommon adverse events.

Drug-susceptible tuberculosis treatment outcomes and its associated factors among inmates in prison settings in Bauchi State, Nigeria, 2014-2018.

Tuberculosis (TB) is a contagious disease and its transmissibility is increased in congregate settings. TB incidence rates are five-to-fifty times higher among inmates in prison settings than the general population which has a direct impact on the outcome of TB treatment. There is paucity of information on TB treatment outcomes and its associated factors in Nigerian prison settings. We therefore assessed TB treatment outcomes among inmates in prison settings in Bauchi State, Nigeria. We conducted a retrospective data analysis of inmates with TB in the five-main prison settings in Bauchi State. We extracted socio-demographic, clinical and treatment outcome characteristics from TB treatment register of inmates treated for TB between January 2014 and December 2018, using a checklist. We calculated the TB treatment success rate (TSR) and explored the relationship between the TSR and socio-demographic and clinical characteristics. Related variables were modelled in multiple logistic regression to identify factors associated with TSR at 5% level of significance. All 216 inmates were male with mean (SD) age of 37.6±11.4 years. Seventy-six (35.2%) were cured, 61 (28.2%) completed treatment, 65 (30.1%) were transferred-out without evaluation and 14 (6.5%) died. Overall TSR was 72.9%. Factors associated with successful-treatment-outcome were age, weight, imprisonment duration and HIV status. The results indicate that inmates who are 20-29 years are at least ten times more likely to be successful (aOR = 10.5; 95%CI: 3.2-35.1) than inmates who are 55 years or older. Inmates who are 30-39 years are about four times more likely to be successful than inmates who are 55 years or older (aOR = 4.2; 95% CI: 1.3-13.1). In general, the younger an inmate, the more successful he is. Inmates with pretreatment-weight; 55kg or more are 13 times more likely to be successful (aOR = 13.3; 95%CI: 6.0-29.6) than inmates with weight below 55kg. Inmates who were imprisoned for 2 years or less are about three times more likely to be successful (aOR = 2.6; 95%CI: 1.3-5.4) than inmates who were imprisoned for more than 2 years and HIV negative inmates were three times more likely to succeed (aOR = 3.3; 95%CI:1.4-7.8) than inmates who were HIV positive. We recommended that to improve TB treatment outcome among inmates; age, duration-of-imprisonment, weight and TB/HIV co-infection should be the major consideration during pretreatment, psychological and nutritional counselling and a tracking-system be developed by the authority to follow-up inmates transferred-out to other health facilities to ensure they complete the treatment and outcomes evaluated.

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.

Beyond drug treatment: a cross-sectional assessment of palliative care services for people living with HIV/AIDS at public health facilities, Abuja, Nigeria.

INTRODUCTION: palliative care offers a care and support system to people living with Human Immunodeficiency Virus (HIV) infection/Acquired Immunodeficiency Syndrome (AIDS). In Nigeria, the palliative care (PC) practice generally is new and still developing. While most studies on HIV/AIDS assess drug treatment and adherence for people living with HIV/AIDS (PLWHA), there is paucity of data on PC services available for them. We therefore assessed the PC services offered and referral services available to PLWHA in health facilities. METHODS: we conducted a cross-sectional study across all public secondary and tertiary health facilities offering HIV care services in Abuja, Nigeria between February and May 2017. We used an interviewer-administered semi-structure questionnaire to collect information from the heads of health facilities. The questionnaire assessed palliative care and referral services for PLWHA. Frequencies and proportions were calculated using Microsoft-Excel. RESULTS: of the 17 health facilities assessed, only 6 (35.3%) have constituted a palliative care team but only 3 (17.6%) had some sources of fund for PC. Twelve (70.6%) provided nutritional support for PLWHA, 6 (35.3%) provided spiritual and 8 (47.1%) offered bereavement support for families of PLWHA. Sixteen (94.1%) had well-established referral services for PLWHA. CONCLUSION: palliative care services for PLWHA were generally poor in all the health facilities. There exists a well-established referral services for PLWHA in most of the health facilities. We recommend that the PC structure for PLWHA should be improved by increasing and ensuring compliance to guidelines and the established referral network should continue to be strengthened.

Serological markers and risk factors associated with Hepatitis B virus infection among Federal Capital Territory prison inmates, Nigeria: Should we be concerned?

INTRODUCTION: Hepatitis B virus (HBV) infection is hyper-endemic in Nigeria. Prisons are high-risk environments for the spread of infectious diseases. Worldwide, seroprevalence of HBV infection is substantially higher among individuals in correctional facilities when compared to general population. We determined the seroprevalence and risk factors associated with HBV infection among Kuje prison inmates, Nigeria. MATERIAL AND METHODS: We conducted a prison facility based cross-sectional study. Interviewer administered questionnaires were used to obtain information on participants socio-demographic characteristics, HBV risk factors, previous HBV test and vaccination history. Blood samples collected from participants were analysed for HBsAg, HBsAb, HBcAb, HBeAg and HBeAb markers using rapid lateral chromatographic immunoassay kit. Univariate, bivariate, and multivariate analysis were performed. RESULTS: A total of 271 inmates (63 convicts and 208 awaiting trial inmates) were recruited into the study as participants. The mean age of the participants was 32.7 SD±9 years. HBV seroprevalence (HBsAg) of 13.7% (95% CI: 9.8-18.3) was found. 55.4% (95% CI: 49.2-61.4) of inmates were susceptible to HBV infection, 20.7% (95%CI; 16.0-26.0) had past HBV infection while 10.3% (95% CI: 7.0-14.6) had acquired natural or artificial HBV immunity. Factors found to be associated with current HBV infection (HBsAg) include age-group ≤25years (aOR = 8.0,95% CI: 2.9-22.3), being ever married (aOR = 4.2, 95% CI: 1.7-10.4) and history of alcohol consumption (aOR = 3.4, 95% CI: 1.3-8.4). CONCLUSION: This study reveals a high seroprevalence of HBV infection among Kuje Prison inmates, hence the need to introduce prison-focused health intervention initiatives such as HBV screening, vaccination and care to reduce the transmission of HBV infection among inmates and ultimately the general population.

Awareness and use of folic acid among women of childbearing age in Benue State, Nigeria.

INTRODUCTION: every year in Nigeria 12,695 babies are born with neural tube defects. Folic acid reduces the risk of neural tube defect by about 50% among peri-conceptional users. We conducted this study to determine the awareness and use of folic acid among women of childbearing age in Benue State, Nigeria. METHODS: we conducted a cross-sectional study among women attending selected among six secondary health facilities in Benue State using a multi-stage sampling technique. We interviewed 586 women aged 15-49 years using structured questionnaires to obtain information on awareness and use of folic acid. We performed univariate, bivariate and multivariate analysis at 5% significance. RESULTS: interviewed 586 women with the mean age 27 ± 6.9 years; 281(48%) were aware of folic acid as a supplement, 178 (30.4%) knew the dietary source of folic acid while 152 (26%) knew the benefit of folic acid. The commonest source of information was health professionals [195 (51%)]. Only 221 (37.7%) used folic acid, 14 (1.7%) of them using it within the first trimester. The commonest reason why women did not take folic acid as supplement was unpleasant smell [124 (21%)]. Awareness of folic acid benefit (OR: 6, 95%CI = 3.9-8.8), level of education (OR: 2.0, 95%CI = 1.2-3.3) and employment status (OR: 1.6, 95%CI= 1.1-22) were significantly associated with folic acid use. Awareness of folic acid use was an independent predictor of folic acid use (AOR: 7.9 95%Cl: 5.3-11.7). CONCLUSION: awareness and use of folic acid among women of childbearing age was low. Awareness is a predictor of folic acid use. We recommend the promotion of awareness and use of folic acid in pregnant women.

Prevalence and correlates of intimate partner violence, before and during pregnancy among attendees of maternal and child health services, Enugu, Nigeria: mixed method approach, January 2015.

INTRODUCTION: Intimate Partner Violence (IPV) is an under-reported public health problem. This study determined the prevalence of IPV and types of IPV, complications and factors associated with IPV among women accessing health services. METHODS: we conducted a cross-sectional survey of 702 women accessing maternal and child health services in Enugu State, Nigeria using multi-stage sampling technique. Quantitative data was collected using semi-structured questionnaire, qualitative data by key informant interview (KII). We analysed data using descriptive statistics, bivariate and multivariate logistic regression analysis. The level of statistical significance was set at p-value < 0.05. Qualitative data was analysed using thematic content analysis. RESULTS: mean age of respondents was 27.71 ± 5.14 years and 654 (93.2%) were married. Prevalence of IPV, a year before last pregnancy, was 307 (43.7%) and during last pregnancy was 261 (37.2%). Frequent involvement in physical fights with other men, controlling behaviour and younger aged partners (< 40 years) were independent predictors of IPV experience both before and during pregnancy. Independent predictors of IPV experience before and during pregnancy were younger aged partners (< 40 years). [Adjusted Odds Ratio AOR 1.72; 95% confidence interval (CI) = 1.17, 2.53], partner having controlling behaviour AOR 2.24; 95% C.I=1.51-3.32) and Partner's frequent involvement in physical fights (AOR 2.29; 95% C.I = 1.43-3.66). Having a male child and married/cohabiting were protective against violence. KII revealed poverty, lack of education and infidelity as common triggers of IPV. CONCLUSION: the prevalence of IPV and types of IPV was high and the predisposing factors of IPV in Enugu were multifactorial. Couple counselling sessions that focus on non-violence conflict resolution techniques is crucial to end IPV.

Knowledge, attitudes and practices towards rabies prevention among residents of Abuja municipal area council, Federal Capital Territory, Nigeria.

INTRODUCTION: Rabies is a fatal neglected zoonosis killing 55,000 people worldwide annually. It is endemic in Nigeria with 10,000 people exposed annually through dog-bites. To inform adequate intervention due to the rise in reported dog-bite cases, we assessed knowledge, attitudes and practices (KAP). METHODS: We carried out a cross-sectional study among 224 residents in Abuja Municipal Area Council. We used structured questionnaires to collect data on sociodemographic characteristics, knowledge and attitudes on rabies prevention. Knowledge score of ≥ 8 points based on ten-point domain question were regarded as satisfactory. We analyzed data using Epi-Info and Excel for proportions and associations were determined at 5% significance level. RESULTS: A total of 123 (55%) respondents owned dogs. One hundred and eighty four (82%) respondents had satisfactory knowledge on rabies prevention, about 87% knew where to get dogs vaccinated and would seek medical treatment from the hospital when bitten by a dog. Majority (58%) did not know the frequency of anti-rabies administration for dogs and 63.3% did not know the appropriate first aid actions following dog-bites. Of 123 dog owners, 35% would allow their dogs roam without restriction and 94% reported vaccinating their dogs against rabies. Dog owners were more likely to have satisfactory knowledge of rabies compared to non-dog owners (OR 7.8, 95% CI 1.0-62.0, p = 0.02). CONCLUSION: Knowledge on rabies is satisfactory but with gaps in the frequency of dog anti-rabies vaccination, appropriate first-aid following dog bites and non restriction of dog movement. To prevent rabies, these gaps need to be addressed through public enlightenment and enforcement of dog movement restrictions laws.

Epidemiological profile of the Ebola virus disease outbreak in Nigeria, July-September 2014.

INTRODUCTION: In July 2014, Nigeria experienced an outbreak of Ebola virus disease following the introduction of the disease by an ill Liberian Traveler. The Government of Nigeria with the support of Technical and Development Partners responded quickly and effectively to contain the outbreak. The epidemiological profile of the outbreak that majorly affected two States in the country in terms of person, place and time characteristics of the cases identified is hereby described. METHODS: Using field investigation technique, all confirmed and probable cases were identified, line-listed and analysed using Microsoft Excel 2007 by persons, time and place. RESULTS: A total of 20 confirmed and probable cases; 16 in Lagos (including the index case from Liberia) and 4 in Port Harcourt were identified. The mean age was 39.5 ± 12.4 years with over 40% within the age group 30-39 years. The most frequent exposure type was direct physical contact in 70% of all cases and 73% among health care workers. The total case-fatality was 40%; higher among healthcare workers (46%) compared with non-healthcare workers (22%). The epidemic curve initially shows a typical common source outbreak, followed by a propagated pattern. CONCLUSION: Investigation revealed the size and spread of the outbreak and provided information on the characteristics of persons, time and place. Enhanced surveillance measures, including contact tracing and follow- up proved very useful in early case detection and containment of the outbreak.