Prevalence and Predictors of Tobacco Use Among Adolescents in Ibadan, Nigeria.

INTRODUCTION: Most tobacco use begins in adolescence, causing dependence and prolonged use, and accounts for more than 8 million deaths worldwide annually. Monitoring adolescent tobacco use is critical to controlling it. Our study examined the prevalence and factors associated with tobacco use among adolescents in Nigeria. METHODS: We conducted a descriptive cross-sectional study among adolescent students in Ibadan, Nigeria, aged 11 to 18 years, from March through June 2021. We used a 2-stage cluster design to select 3,199 students from 23 schools. We adapted the Global Youth Tobacco Survey Core Questionnaire, version 1.2, for data collection and used logistic regression to assess factors associated with current tobacco use. We weighted all analyses for complex survey design and differential nonresponse at school, class, and student levels. RESULTS: Prevalence of current use of cigarettes, smokeless tobacco, or any tobacco were 1.4%, 1.1%, and 2.0%, respectively. Predictors of current tobacco use were male sex (adjusted odds ratio [aOR] = 3.13; 95% CI, 1.53-6.42); close friends as smokers (aOR = 3.10; 95% CI, 1.77-5.41); classmates as smokers (aOR = 3.12; 95% CI, 1.15-8.49); access to cigarette (aOR = 6.65; 95% CI, 2.55-17.33); perception that smoking is attractive (aOR = 3.15; 95% CI, 1.17-8.44); exposure to secondhand smoke (aOR = 2.93; 95% CI, 1.07-8.03); and internet awareness of tobacco use (aOR = 3.22; 95% CI, 1.48-7.04). CONCLUSION: Prevalence of adolescent tobacco use was low in Ibadan. Predictors were peer influence, access to cigarettes, misperceptions about tobacco use, exposure to secondhand smoke, and tobacco advertising. We recommend an antitobacco campaign that uses a peer education strategy, a comprehensive enforcement of tobacco advertising, and a ban on public smoking.

Predictors of Lassa fever diagnosis in suspected cases reporting to health facilities in Nigeria.

Lassa fever (LF) remains endemic in Nigeria with the country reporting the highest incidence and mortality globally. Recent national data suggests increasing incidence and expanding geographic spread. Predictors of LF case positivity in Nigeria have been sparsely studied. We thus sought to determine the sociodemographic and clinical determinants of LF positivity amongst suspected cases presenting to health facilities from 2018 to 2021. A secondary analysis of the national LF surveillance data between January 2018 and December 2021. Socio-demographic and clinical data of 20,027 suspected LF cases were analysed using frequencies and Chi-square statistics with significant p-value set at p < 0.05. The outcome variable was LF case status (positive or negative). Predictors of LF case positivity were assessed using multiple logistic regression models with 95% confidence intervals (CI). Case positivity rate (CPR) for the four years was 15.8% with higher odds of positivity among age group 40-49 years (aOR = 1.40; 95% CI 1.21-1.62), males (aOR = 1.11; 95% CI 1.03-1.20), those with formal education (aOR = 1.33; 95% CI 1.13-1.56), artisans (aOR = 1.70; 95% CI 1.28-2.27), religious leaders (aOR = 1.62; 95% CI 1.04-2.52), farmers (aOR = 1.48; 95% CI 1.21-1.81), and symptomatic individuals (aOR = 2.36; 95% CI 2.09-2.68). Being a health worker (aOR = 0.69; 95% CI 0.53-0.91), a teacher (aOR = 0.69; 95% CI 0.53-0.89) and cases reporting in the 3rd quarter (aOR = 0.79; 95% CI 0.69-0.92) had lower odds. In a sex-disaggregated analysis, female farmers had higher odds of positivity (aOR = 2.43; 95% CI 1.76-3.38; p < 0.001) than male farmers (aOR = 1.52; 95% CI 1.19-1.96; p < 0.01). Fever (aOR = 2.39; 95% CI 2.00-2.84) and gastrointestinal (GI) symptoms (aOR = 2.15; 95% CI 1.94-2.37) had the highest odds among symptoms. Combination of fever and GI symptoms (aOR = 2.15; 95% CI 1.50-3.10), fever and neurological symptoms (aOR = 6.37; 95% CI 1.49-27.16), fever and musculo-skeletal symptoms (aOR = 2.95; 95% CI 1.37-6.33), fever and cardiopulmonary symptoms (aOR = 1.81; 95% CI 1.24-2.64), and cardiopulmonary and general symptoms (aOR = 1.50; 95% CI 1.19-1.89) were also predictive. Cumulative LF CPR appears high with clearly identified predictors. Targeted interventions with heightened index of suspicion for sociodemographic categories predictive of LF in suspected cases are recommended. Ethnographic and further epidemiological studies could aid better understanding of these associations.

Epidemiological trends of Lassa fever in Nigeria, 2018-2021.

BACKGROUND: Lassa fever is a viral haemorrhagic fever endemic in Nigeria. Improved surveillance and testing capacity have revealed in an increased number of reported cases and apparent geographic spread of Lassa fever in Nigeria. We described the recent four-year trend of Lassa fever in Nigeria to improve understanding of its epidemiology and inform the design of appropriate interventions. METHODS: We analysed the national surveillance data on Lassa fever maintained by the Nigeria Centre for Diseases Control (NCDC) and described trends, sociodemographic, geographic distribution, and clinical outcomes. We compared cases, positivity, and clinical outcomes in the period January 2018 to December 2021. RESULTS: We found Lassa fever to be reported throughout the year with more than half the cases reported within the first quarter of the year, a recent increase in numbers and geographic spread of the virus, and male and adult (>18 years) preponderance. Case fatality rates were worse in males, the under-five and elderly, during off-peak periods, and among low reporting states. CONCLUSION: Lassa fever is endemic in Nigeria with a recent increase in numbers and geographical distribution. Sustaining improved surveillance, enhanced laboratory diagnosis and improved case management capacity during off-peak periods should remain a priority. Attention should be paid to the very young and elderly during outbreaks. Further research efforts should identify and address specific factors that determine poor clinical outcomes.

The Nigerian Military Public Health Response to COVID-19: A 14-Month Appraisal.

The COVID-19 pandemic has caused significant morbidity and mortality since its emergence in December 2019. In Nigeria, the government inaugurated the Presidential Task Force on COVID-19 to coordinate resources while the Nigeria Centre for Disease Control led the public health response. The Nigeria Ministry of Defence Health Implementation Programme (MODHIP), in partnership with the US Army Medical Research Directorate - Africa/Nigeria, responded immediately to the pandemic by establishing a public health emergency operations center to coordinate the military response in support of national efforts. MODHIP has 5 functional units and 6 pillars that coordinate testing, surveillance, case management, risk communication, logistics, research, and infection prevention and control. It developed an incident action plan and each pillar had its own terms of reference to guide specific response activities while preventing duplication of efforts within the military and the Nigeria Centre for Disease Control. In addition, awareness and sensitization sessions were conducted on preventive practices for COVID-19 and infrastructure was provided for hand hygiene and screening at all military facilities. Military laboratories were configured for SARS-CoV-2 testing while selected military health facilities were equipped and designated as COVID-19 treatment centers. Research proposals aimed at better understanding the disease and controlling it were also developed. The traditional combat role of the military was redirected to complement this public health emergency response. In this article, we highlight gaps, opportunities, and lessons to improve military participation in public health emergency response in the future. More funding and multisectoral collaboration with civilian institutions are key to strengthening military public health emergency preparedness and response capabilities.

Trend and enhanced surveillance of Monkeypox during COVID-19 pandemic in Nigeria.

Monkeypox (MPX) is a viral zoonosis with lesions like smallpox. Though rare in Nigeria, sporadic outbreaks have been reported in 17 states since September 2017. Unfortunately, the COVID-19 pandemic has further reduced surveillance and reporting of MPX disease. This study seeks to assess the effect of an enhanced surveillance approach to detect MPX cases and measure the cumulative incidence of MPX in priority states in Nigeria. We identified three priority states (Rivers, Delta and Bayelsa) and their Local Government Areas (LGAs) based on previous disease incidence. We also identified, trained, and incentivized community volunteers to conduct active case searches over three months (January to March 2021). We supported case investigation of suspected cases and followed up on cases in addition to routine active surveillance for MPX in health facilities and communities. Weekly and monthly follow-up was carried out during the same period. Out of the three states, 30 hotspots LGAs out of the 56 LGAs (54%) were engaged for enhanced surveillance. We trained three state supervisors, 30 LGA surveillance facilitators and 600 Community informants across the three priority states. Overall, twenty-five (25) suspected cases of MPX were identified. Out of these, three (12%) were confirmed as positive. Enhanced surveillance improved reporting of MPX diseases in hotspots LGAs across the priority states. Extension of this surveillance approach alongside tailored technical support is critical intra and post-pandemic.

Prevalence, patterns and correlates of smokeless tobacco use in Nigerian adults: An analysis of the Global Adult Tobacco Survey.

INTRODUCTION: The global tobacco epidemic contributes to more than 8 million deaths annually. However, most tobacco control interventions have been driven by an emphasis on smoked tobacco. Globally and more so in Nigeria, less attention has been paid to the similarly harmful smokeless tobacco (SLT) whose use appeals to a different demography. We examined the prevalence, patterns of use and correlates of SLT in Nigerian adults to guide targeted control efforts. METHODS: We conducted a secondary analysis of the 2012 Global Adult Tobacco Survey (GATS) data. We obtained data on 9,765 non-institutionalised adults aged 15 years and older. Variables included current SLT use, sociodemographic characteristics and perceived harm of SLT use. We used Chi-square test to examine associations and binary logistic regression to assess predictors of current SLT use. All analyses were conducted with sample-weighted data. RESULTS: The prevalence of current SLT use was 1.9% of all adults. About 1.4% were daily users. The main types were snuff by nose (1.6%) and snuff by mouth (0.8%). There were higher odds of current SLT use for those in the South-East region (aOR = 13.99; 95% CI: 4.45-43.95), rural area residents (aOR = 1.56; 95% CI: 1.04-2.35), males (aOR = 4.43; 95% CI: 2.75-7.11), the 45-64 years age-group (aOR = 10.00; 95% CI: 4.12-24.29), those with no formal education (aOR = 2.67; 95% CI: 1.01-7.05), and those with no perception of harm from SLT use (aOR = 3.81, 95% CI: 2.61-5.56). CONCLUSION: The prevalence of SLT use among Nigerian adults was low with clearly identified predictors. While a majority were aware of harm from SLT use, an unacceptably high proportion remain unaware. We recommended targeted interventions to increase awareness of the harmful effects of SLT use especially among residents of the South-East, those in rural areas, males, and individuals with no formal education. We also recommended a follow-up survey.

Reference intervals of common clinical biochemistry analytes in young Nigerian adults.

BACKGROUND: Reference intervals are assessment tools for interpretation of clinical test results. These intervals describe the dispersion of test parameter values of apparently healthy persons in defined populations as health status indicators. Using reference intervals obtained and validated in populations outside the geographical region of derivation for medical decision-making may impact negatively on clinical interpretation and patient management. Many countries have established their reference values, current studies on these data for Nigeria are however scarce. Determination of clinical biochemistry reference intervals for young Nigerian adults which is of particular importance in routine clinical management and conduct of clinical trials in response to existing and emerging diseases will add significantly to the existing body of knowledge. OBJECTIVE: The objective was to establish reference intervals for 24biochemistry analytes among Nigerians aged 18 to 26 years. METHODS: This was a cross-sectional study among 7,797 consenting male and female military applicants aged 18 to 26 years from 37 States of Nigeria. It was a total study among volunteers for military service. Blood samples were collected and subjected to serological testing for HIV-1 and 2, hepatitis-B, malaria, pregnancy and haematuria to restrict our study population to apparently healthy participants. Biochemical assays were performed on 6,169 participant samples that met the inclusion criteria. Generated data was entered into MS Excel® and exported into SPSS® software version 16 for analysis. Statistical tools used were frequencies, median, mid 95th percentile range with 2.5th and 97.5th percentiles as limits. Reference intervals were estimated using nonparametric methods. No intergender statistical comparison was made. RESULTS: Complete records were obtained for 6,169 eligible participants. Median values and associated reference intervals were similar in both genders. CONCLUSION: The findings from this study will help in clinical decision-making and play a significant role in supporting the current global rapid expansion of clinical trials in response to the urgent need for preventive and therapeutic solutions to existing and emerging diseases.

The experiences of healthcare workers during the COVID-19 crisis in Lagos, Nigeria: A qualitative study.

INTRODUCTION: The novel coronavirus (COVID-19) pandemic has overwhelmed health systems globally. Healthcare workers (HCWs) are faced with numerous challenges during the COVID-19 response. In this study, we aimed to describe the experiences of HCWs during the COVID-19 outbreak in Lagos, Nigeria. METHODS: We conducted a qualitative study on the experiences of frontline HCWs at the COVID-19 isolation centers in Lagos, Nigeria using purposive and snowballing sampling techniques. An in-depth interview which lasted for 25-40 minutes for each respondent was conducted among ten medical officers and four nurses between 15th June and 13th July 2020. We analyzed data using Colaizzi's phenomenological method. RESULTS: Respondents' age ranged between 29 and 51 years with a median age of 36.5 years. Four themes were identified from data analysis. In the first theme, "COVID-19 care: A call to responsibility", HCWs expressed optimism regarding COVID-19 care, and described the work conditions at COVID-19 isolation centers. In the second theme, "Challenges encountered while caring for COVID-19 patients - coping strategies", HCWs experienced difficulties working in a new environment and with limited resources. They however coped through the available support systems. Regarding the "Experiences in COVID-19 care", the feelings of HCWs varied from pleasure on patients' recovery to distress following patients' demise. On the "Necessities in COVID-19 care", HCWs identified the need for increased psychosocial support, and adequate provision of material and financial support. CONCLUSIONS: HCWs at COVID-19 isolation centers need to be assured of a safe working environment while providing them with a strengthened support system.