Mpox in pregnancy: Management, risks and challenges in Africa and lessons from the COVID-19 pandemic.

Data on mpox in pregnancy are currently limited. Historically, only 65 cases in pregnancy have been reported globally since mpox was discovered in 1958. This includes 59 cases in the current outbreak. Vertical transmission was confirmed in one patient. Pregnant women are at high risk of severe disease owing to immunological and hormonal changes that increase susceptibility to infections in pregnancy. African women appear to be at higher risk of mpox infection and adverse outcomes in pregnancy for epidemiological and immunologic reasons, in addition to the background high rates of adverse feto-maternal outcomes in the region. This risk is potentially heightened during the COVID-19 pandemic due to the possibility of mpox virus exportation/importation as a result of the lifting of movement restrictions and trans-border travels between countries affected by the current outbreak. Furthermore, coinfection with mpox and COVID-19 in pregnancy is possible, and the clinical features of both conditions may overlap. Challenges of diagnosis and management of mpox in pregnancy in Africa include patients concealing their travel history from healthcare providers and absconding from/evading isolation after diagnosis, shortage of personal protective equipment and polymerase chain reaction testing facilities for diagnosis, vaccine hesitancy/resistance, and poor disease notification systems. There is a need for local, regional and global support to strengthen the capacity of African countries to address these challenges and potentially reduce the disease burden among pregnant women in the continent.

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.

Post-Discharge Symptoms among Hospitalized COVID-19 Patients in Nigeria: A Single-Center Study.

There is a paucity of studies on post-acute COVID-19 syndrome (PCS) among hospitalized COVID-19 survivors from Nigeria. We describe the frequency, types, and duration of post-discharge symptoms suggestive of PCS among previously hospitalized COVID-19 patients in a treatment center in Nigeria. We conducted a retrospective review of admission and post-discharge follow-up medical records of COVID-19 survivors admitted between April and December 2020. A standardized checklist was used to document post-discharge symptoms. PCS was defined as persisting or new post-discharge symptoms lasting at least 3 weeks after initial COVID-19 symptoms. The relationship between study variables and development of PCS was ascertained by univariate analysis. Thirty of 51 previously hospitalized COVID-19 patients (median age, 46 years; male, 66.7%) were studied. Seventeen (56.7%) of the 30 patients developed features suggestive of PCS. Approximately three post-discharge symptoms were reported per patient over a follow-up period of ranging from 3 weeks to 9 months after initial COVID-19 symptoms. Cough, fatigue, and dyspnea were the most common post-discharge symptoms reported. A few patients had symptoms suggestive of thrombosis and COVID-19 reinfection. Among all study variables, baseline COVID-19 severity was the only significant variable associated with the development of PCS. PCS is common in our setting and is characterized by multisystemic signs and symptoms that require vigilance by clinicians for appropriate diagnosis and treatment. Long-term multicenter prospective studies are needed to characterize fully the burden of PCS among COVID-19 survivors in Nigeria.

Fumigation of Schools for COVID-19 Prevention in Nigeria: The Need for a Rethink.

The government of Nigeria ordered closure of schools to slow the spread of COVID-19 when the pandemic hit the country. About 5 months into the outbreak, secondary schools have been reopened to allow students to write their terminal examinations. Many state governments and school owners are fumigating their schools as a way of disinfecting the school environment and ensuring safe resumption of academic activities. We discuss the undue attention given to fumigation in this instance and stress the importance of addressing more beneficial and sustainable strategies to prevent COVID-19 in Nigerian schools.

Improving Appropriate Use of Medical Masks for COVID-19 Prevention: The Role of Face Mask Containers.

Use of medical masks is a key strategy for COVID-19 prevention among healthcare workers. Unfortunately, there are global shortages of this essential commodity, and many have resulted in inappropriate usage to conserve supply. This article highlights the likely benefits of face mask containers in promoting safe, appropriate, and extended use of medical masks by healthcare workers in settings where a sustainable supply of medical masks may be limited.

COVID-19: The Need for Rational Use of Face Masks in Nigeria

Because of the pandemic of COVID-19, the federal government of Nigeria has instituted a mandatory policy requiring everyone going out in public to wear face masks. Unfortunately, the Nigeria media is awash with images of misuse and abuse of face masks by the public, government officials, and healthcare workers. Medical masks are used widely in community settings amid reported scarcity within healthcare facilities. It is observed that some people wear face masks on their chin and neck, and mask wearers give no attention to covering their mouth and nose, especially when talking. Used face masks are kept with personal belongings or disposed indiscriminately in public spaces, leading to self and environmental contamination. Inappropriate use and disposal of face masks in Nigeria could promote the spread of the novel coronavirus in the country and negate the country's efforts to contain the COVID-19 pandemic. In the implementation of the universal masking policy in Nigeria, federal and state governments ought to consider local applicability, feasibility, and sustainability, as well as identify and mitigate all potential risks and unintended consequences. Also critical is the need for intensive public sensitization and education on appropriate use and disposal of face masks in the country.