Varying behavioral differences and correlates of HPV infection among young adolescents in Benue state, Nigeria.

BACKGROUND: Human Papillomavirus (HPV) infection is a significant public health concern globally, especially in low- and middle-income countries. In Africa, including Nigeria, HPV prevalence is high, contributing to a substantial burden of cervical cancer. Despite challenges, massive HPV vaccination campaigns in Africa show promise for preventing cervical cancer cases. In Benue State, Nigeria, limited research exists on several aspects of HPV knowledge and attitudes towards HPV among secondary school students. This study aims to bridge this gap by assessing HPV knowledge, prevention practices, willingness to uptake HPV vaccination, and associated attitudes and behaviors among secondary school students in the state. METHODS: The cross-sectional study was conducted among adolescents aged 10-19 years in six secondary schools in three local government areas (LGAs) in Benue State, Nigeria. Two-stage sampling was used to select the LGAs and schools, with a final sample size of 591 students. The selected schools represent both junior and senior secondary school levels and span across the three senatorial districts of the state. Data were collected using a self-administered questionnaire covering sociodemographic characteristics, HPV knowledge, prevention practices, and willingness for HPV vaccination. Statistical analyses included univariate analyses and tests of association, with significance set at p < 0.05 or 0.001 depending on the level of the stringency of the evidence required. Data were analyzed using SPSS version 25. RESULTS: Only 35.4% of the participants were males, and 86.8% were between the ages of 10 and 16. Only 24.7% acknowledged that HPV can be transmitted during sexual intercourse, and 36.2% recognized that HPV can be transmitted via skin-to-skin contact. 48.1% noted that HPV can cause cervical cancer. Half (50.9%) acknowledged that early sexual debut increases the risk of acquiring HPV, while only 28.1% recognized vaccination as a preventive strategy against HPV infection. Only 35% correctly stated the best time for the HPV vaccine. In assessing the practice of HPV prevention, 14.9% are in a sexual relationship and 10.3% admitted to not using condoms during sexual intercourse. Also, 11.8% have had STIs, and 27.2% have previously undergone HIV screening. Various bivariate analyses showed some varying behavioral differences and correlates of HPV infection among young adolescents in Benue State, Nigeria. CONCLUSIONS: This study provides valuable insights into HPV knowledge, prevention practices, and willingness to uptake HPV vaccination among secondary school students in Benue State, Nigeria. The significance of the differences and correlates was discussed using themes. The research has unpacked complex relationships that could have public health implications for researchers and policymakers. Moreover, ten actionable policy recommendations were prescribed. Several interventions and areas for further study were proposed.

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.

Effects of seasonality on access to improved water in Benue State, Nigeria.

Many people switch sources of drinking water and sanitation between seasons, yet such shifts are not reflected in the reporting of access to improved water and sanitation services by the Joint Monitoring Programme (JMP). Drawing on quantitative and qualitative data collected from urban and rural sites in dry and rainy seasons in Benue state, Nigeria, this study highlights the importance of seasonal variations in water access and quality. Water testing showed that water sources had higher levels of contamination with coliforms, nitrate and chloride in the dry season than the wet season. The contamination of water from these pollutants is above WHO standards and believed to come mainly from pit latrines. Semi-structured interviews revealed that many people who use improved water and sanitation facilities in the rainy season sometimes switch to poorer quality unimproved sources in the dry season. Travel times for collecting water as well as waiting times also significantly increased in the dry season. It is recommended that this important seasonality element is factored into JMP data collection and reporting.

Assessment of provider-initiated HIV screening in Nigeria with sub-Saharan African comparison.

BACKGROUND: Despite Nigeria's high HIV prevalence, voluntary testing and counselling rates remain low. UNAIDS/WHO/CDC recommends provider-initiated testing and counselling (PITC) for HIV in settings with high HIV prevalence. We aimed to assess the acceptability and logistical feasibility of the PITC strategy among adolescents and adults in a secondary health care centre in Idekpa Benue state, Nigeria. METHOD: All patients (aged ≥ 13 years) who visited the out-patient department and antenatal care unit of General Hospital Idekpa, Benue state, Nigeria were offered PITC for HIV. The intervention was implemented by trained health professionals for the period spanning (June to December 2010). RESULTS: Among the 212 patients who were offered PITC for HIV, 199 (94%) accepted HIV testing, 10 patients (4.7%) opted out and 3 patients (1.4%) were undecided. Of the 199 participants who were tested for HIV, 9% were HIV seropositive. The PITC strategy was highly acceptable and feasible, and increased the number of patients who tested for HIV by 5% compared to voluntary counselling and testing. Findings from this assessment were consistent with those from other sub-Saharan African countries (such as Uganda and South Africa). CONCLUSION: PITC for HIV was highly acceptable and logistically feasible, and resulted in an increased rate of HIV testing among patients. Public health initiatives (such as the PITC strategy) that facilitate early detection of HIV and referral for early treatment should be encouraged for broader HIV control and prevention in Nigerian communities.

Isolation and Immunological Detection of Mycobacterium Tuberculosis from HIV and Non-HIV Patients in Benue State, Nigeria.

BACKGROUND: Immunological techniques are important tools for tuberculosis epidemiology; although its use is underutilized in Nigeria. In this study, we report the epidemiological outlook of Mycobacterium tuberculosis among HIV patients in Benue State, Nigeria. METHODS: Sputum samples were collected from 425 suspected TB patients from July 2016 to February 2018 and subjected to acid-fast microscopy, GeneXpert MTB/RIF, processed using NALC-NaOH and cultured on Lowenstein-Jensen media. The isolates obtained were identified by SD-Bioline® assay. RESULTS: The prevalence of TB by acid-fast microscopy was 35(15.9%). The prevalence of TB by acid-fast bacilli was significantly (χ2 = 8.458; P = 0.003) highest among the 15-34 years age group (22.0%) compared with other age groups. TB prevalence was significantly (χ2 = 4.751; P = 0.029) higher among patients from rural areas than those from urban center (23.8% vs 14.1%). GeneXpert assay detected 64(15.1%) TB cases of which patients from rural areas had significantly (χ2 = 8.104; P = 0.017) higher prevalence of TB than patients from urban areas (23.8% vs 12.9%). The overall rifampicin resistance TB was 3.1%. Also, patients from rural areas had significantly (χ2 = 10.625; P = 0.005) higher rifampicin resistance compared with patient from urban areas (8.3% vs 1.3%). Of the 126(29.7%) mycobacterial isolates, 42(33.33%) were identified as MTBC and 84 (66.67%) as NTM by SD-Bioline® assay. CONCLUSIONS: The study revealed that Mycobacterium tuberculosis infection is still a major public health problem, with relatively high prevalence rate of rifampicin resistance among HIV positive patients. Further studies are needed for early detection and treatment intervention necessary for infection control.

Prevalence of Trachoma and Access to Water and Sanitation in Benue State, Nigeria: Results of 23 Population-Based Prevalence Surveys.

PURPOSE: We sought to determine the prevalence of trachoma in each local government area (LGA) of Benue State, Nigeria. METHODS: Two-stage cluster sampling was used to conduct a series of 23 population-based prevalence surveys. LGAs were the evaluation units surveyed. In each LGA, 25 households were selected in each of 25 clusters, and individuals aged 1 year and above resident in those households were invited to be examined for trachoma. Data on access to water and sanitation were also collected at household level. RESULTS: A total of 91,888 people were examined from among 93,636 registered residents across the 23 LGAs. The LGA-level prevalence of trachomatous inflammation-follicular (TF) in 1-9 year olds ranged from 0.3% to 5.3%. Two LGAs had TF prevalences of 5.0-9.9%. The LGA-level prevalence of trichiasis in ≥15-year-olds ranged from 0.0% to 0.35%. Access to improved drinking water sources ranged from 0% in Gwer West to 99% in Tarka, while access to improved sanitation ranged from 1% in Gwer West to 92% in Oturkpo. CONCLUSION: There is a need for public health-level interventions against trachoma in three LGAs of Benue State.

Entomological assessment of yellow fever-epidemic risk indices in Benue State, Nigeria, 2010-2011.

Yellow fever (YF) is a vector-borne disease affecting humans and non-human primates in tropical areas. In the past, there have been pockets of YF outbreaks in Nigeria that resulted in preventable deaths. Surveillance efforts towards avoiding another outbreak have been put in place with the aim of early detection and control. However, risk indices relating to the density of immature YF-mosquito vectors are given little consideration even though it is the first step in curbing a possible outbreak. Immature collections from 1538 houses in Ega, Oju, Otukpoicho and Otukpo in Benue State were carried out in 2010 and 2011. Risk indices such as house index (HI), container index (CI) and Breteau index (BI) were estimated. Molecular detection of YF was carried out on randomly selected Aedes larvae and pupae. Overall, 431,381 mosquitoes were collected in and around house premises. Thirteen species were identified: Ae. aegypti (Linneaus), Ae. africanus (Theobald), Ae. albopictus (Skuse), Ae. cumminsii (Theobald), Ae. luteocephalus (Newstead), Ae. simpsoni s.l. (Theobald), Ae. vittatus (Bigot), Anopheles gambiae Giles, An. nili (Theobald), Cx. nebulosus Theobald, Culex quinquefasciatus Say, Lutzia tigripes (Grandpre and Charmoy) and Toxorhynchites brevipalpis Theobald. The HI, CI and BI for Ae. aegypti were high in all the study locations, but low for Ae. lueteocephalus except in Ega. With 50 immature Aedes mosquitoes screened across locations, only Ae. aegypti from Ega were positive for YF. This study places Ega on a high alert of an impending YF outbreak. Thus, urgent steps to clear this area of potential mosquito sites are highly recommended.

Prevalence of Intestinal Parasitic Infections and their Association with Nutritional Status of Rural and Urban Pre-School Children in Benue State, Nigeria.

BACKGROUND AND OBJECTIVES: Intestinal parasitic infections are highly prevalent in developing countries, contributing to high incidence of malnutrition and morbidity. This study aimed to find the prevalence of intestinal parasitic infections and their association with nutritional status of children in Benue State, Nigeria. METHODS: A cross sectional study conducted from January-June 2016, among 418 school children under-5 years of age. Anthropometric data, height-for-age, weight-for-height, and weight-for-age Z-scores from each child and fecal samples were collected and screened for intestinal parasites using standard laboratory methods. RESULTS: Among the intestinal parasitic infections detected, the prevalence of E. histolytica was higher (51.0% and 29.0%) than all other parasites encountered in rural and urban pupils (P<0.05). Other parasites were Hookworm (46.2% and 24.8%); G. lamblia (11.5% and 8.6%); and T. trichiura (2.4% and 5.2%). The prevalence of stunting (HAZ<-2), in rural and urban pupils were 43.8% and 32.9%; 64.4% and 39.0% rural and urban pupils were underweight (WAZ<-2), while 30.3% and 24.3% were wasted (WHZ<-2). Infected children had significantly (P<0.05) higher z-scores than the uninfected children. CONCLUSION AND GLOBAL HEALTH IMPLICATIONS: Benue State is among the Nigerian states with the highest burden of tropical diseases with a current plan of elimination implemented through mass drug administration. This study identify/evaluate some essential information that will support the planning and implementation of the State's ongoing efforts.

Malarial Infection among Antenatal and Maternity Clinics Attendees at the Federal Medical Centre, Makurdi, Benue State, Nigeria.

This study assessed the level of malarial infection in relation to some epidemiological factors, gravidity and pregnancy period of antenatal clinic attendees of the Federal Medical Centre, Makurdi, Benue State, Nigeria. We also assessed malarial infection in placental blood in relation to gravidity of pregnant women at delivery in the maternity clinic of the same hospital. Thin and thick blood films were prepared for microscopic examination. A questionnaire was administered to each pregnant woman at the antenatal clinic to collect data on educational level, occupation, gravidity, pregnancy period, malaria preventive measures and malaria symptoms. Of the 163 pregnant women examined at the antenatal clinic, 68.3% (111/163) were infected with malaria. Pregnant women that are illiterates (χ(2) =15.44, P=0.100) and those that are farmers (χ(2) =9.20, P=0.270) had the highest infection rate with no significant difference respectively. Malarial infection was significantly higher in the multigravidae, 57.6% (34/59) (χ(2) =5.16, P=0.007) and non-significant in the pregnant women at their third trimester of pregnancy, 60.9% (53/89) (χ(2) =4.45, P=0.108). Placental malaria was significantly higher in the primigravidae among pregnant women at delivery (χ(2) =9.33, P=0.000). A significant difference (χ(2) =33.52, P=0.000) was observed between pregnant women that did not use any malaria preventive methods, 91.2% (31/34) and those that used single, 64.3% (65/101) and combined, 46.4% (13/28) methods of prevention. Malaria remains highly prevalent among antenatal clinics attendees in Makurdi, Nigeria. Combined method of prevention (insecticides treated nets and insecticide spray) yielded good results and its use is advocated in preventing malaria among the pregnant women.

Clinical epidemiology of lymphatic filariasis and community practices and perceptions amongst the ado people of benue state, Nigeria.

As part of efforts to initiate lymphatic filariasis elimination activities in Benue State, this study employed the use of lymphatic filariasis-related clinical signs as rapid diagnostic features, immunochromatographic card test (ICT) to detect circulating filarial antigen (CFA) and questionnaire to investigate community perceptions and beliefs. 81 (32.6%) out of the 248 persons were positive for circulating filarial antigen (CFA). Infection rates denoted by CFA ranged from 41 (46.1%) in Uffia to 1(6.6%) in Ijigbam districts. Distribution of community ICT prevalence showed a significant variation (X(2), P < 0.05). The prevalence of clinical signs and/or symptoms in the communities also showed significant variations (X(2), P < 0.05). Community hydrocoele prevalence ranged from 8 (9.0%) in Uffia to 1(6.6%) in Ijigbam. The overall hydrocoele prevalence was 21 (8.5%), while the overall lymphoedema prevalence was 16 (6.4%) and women accounted for 14 (87.5%) of persons with swollen limbs. Only about 14 (15.9%) of unaffected respondents knew that lymphatic filariasis is transmitted through mosquito bites, this differ significantly from affected respondents 10 (66.6%) (X(2), P < 0.05). The communities' capacity to protect themselves is hindered by a lack of understanding of the true cause, symptoms, transmission route and prevention of the disease. Our study demonstrates the need for the development of health education programmes that will enable people to protect themselves against mosquito bites. As Nigeria commence her lymphatic filariasis elimination programmes, there is an urgent need to develop morbidity management activities that will alleviate the burden of patients.