'We delivered at home out of fear': Maternity Care in Rural Nigeria During the COVID-19 Pandemic.

Background and Objective: The COVID-19 pandemic response overwhelmed health systems, disrupting other services, including maternal health services. The disruptive effects on the utilization of maternal health services in low-resource settings, including Nigeria have not been well documented. We assessed maternal health service utilization, predictors, and childbirth experiences amidst COVID-19 restrictions in a rural community of Kumbotso, Kano State, in northern Nigeria. Methods: Using an explanatory mixed methods design, 389 mothers were surveyed in January 2022 using validated interviewer-administered questionnaires, followed by in-depth interviews with a sub-sample (n=20). Data were analyzed using logistic regression models and the framework approach. Results: Less than one-half (n=165, 42.4%) of women utilized maternal health services during the period of COVID-19 restrictions compared with nearly two-thirds (n=237, 65.8%) prior to the period (p<0.05). Non-utilization was mainly due to fear of contracting COVID-19 (n=122, 54.5%), clinic overcrowding (n=43, 19.2%), transportation challenges (n=34, 15.2%), and harassment by security personnel (n=24, 10.7%). The utilization of maternal health services was associated with participant's post-secondary education (aOR=2.06, 95% CI:1.14- 11.40) (p=0.02), and employment type (civil service, aOR=4.60, 95% CI: 1.17-19.74) (p<0.001), business aOR=1.94, 95% CI:1.19- 4.12) (p=0.032) and trading aOR=1.62, 95% CI:1.19-2.94) (p=0.04)). Women with higher household monthly income (≥ N30,000, equivalent to 60 US Dollars) (aOR=1.53, 95% CI:1.13-2.65) (p=0.037), who adhered to COVID-19 preventive measures and utilized maternal health services before the COVID-19 pandemic were more likely to utilize those services during the COVID-19 restrictions. In contrast, mothers of higher parity (≥5 births) were less likely to use maternal health services during the lockdown (aOR=0.30, 95% CI:0.10-0.86) (p=0.03). Utilization of maternal services was also associated with partner education and employment type. Conclusion and Global Health Implications: The utilization of maternal health services declined during the COVID-19 restrictions. Utilization was hindered by fear of contracting COVID-19, transport challenges, and harassment by security personnel. Maternal and partner characteristics, adherence to COVID-19 preventive measures, and pre-COVID maternity service utilization influenced attendance. There is a need to build resilient health systems and contingent alternative service delivery models for future pandemics.

"I Would Rather Take the Vaccine Than Undergo Weekly Testing": Correlates of Health Workers' Support for COVID-19 Vaccine Mandates.

This study examined the support for vaccine mandates and uptake among clinical and non-clinical staff at a tertiary hospital in northern Nigeria, focusing on variation of survey responses based on job position, socio-demographic characteristics, and perceived risk of infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Using an explanatory, sequential, mixed-methods design and deploying a pragmatic paradigm, 370 healthcare workers were administered structured questionnaires. This was followed by in-depth interviews with a sub-sample of respondents to further clarify the responses regarding support for the coronavirus disease 2019 (COVID-19) vaccine mandate. Findings demonstrated that less than one-half of respondents supported the COVID-19 mandate, and only one in three had received the recommended COVID-19 vaccine doses. Support for the vaccine mandate and vaccine uptake were predicted by profession, work experience, number of children, health status, and risk perception. Support for the vaccine mandate was ascribed to ethical and professional duty, whereas opposition was associated with respect for autonomy and human rights. This study documents the need to enhance support for vaccine mandates and uptake among healthcare workers through sustainable strategies, as Nigeria's healthcare workers are considered a source of trust and role models for the rest of society.

Fifth Annual Summer Research Summit on Health Equity Organized by the Center of Excellence in Health Equity, Training and Research, Baylor College of Medicine, Houston, Texas 77030, USA on May 17, 2022

: Academic-Community Partnerships: Change Agents for Advancing Health Equity The fifth annual summer research summit organized by the Center of Excellence (COE) in Health Equity, Training and Research, Baylor College of Medicine (BCM), was held on May 17, 2022. The theme of this year’s summit was ‘Academic-Community Partnerships: Change Agents for Advancing Health Equity.’ Given the ongoing pandemic, the summit was conducted virtually through digital platforms. This program was intended for both BCM and external audiences interested in advancing health equity, diversity, and inclusion in healthcare among healthcare providers and trainees, biomedical scientists, social workers, nurses, and individuals involved in talent acquisition and development, such as hiring managers (HR professionals), supervisors, college and hospital affiliate leadership and administrators, as well as diversity and inclusion excellence practitioners. We had attendees from all regions of the United States as well as from Saudi Arabia. The content in this Book of s encapsulates a summary of the research efforts by the BCM COE scholars (which includes post-baccalaureate students, medical students, clinical fellows, and junior faculty from BCM) as well as the external summit participants. The range of topics in this year’s summit was quite diverse, encompassing disparities in relation to maternal and child health (MCH), immigrant health, cancers, vaccination uptakes, and COVID-19 infections. Various solutions were ardently presented to address these disparities, including community engagement and partnerships, improvement in health literacy, and the development of novel technologies and therapeutics. With this summit, BCM continues to build on its long history of educational outreach initiatives to promote diversity in medicine by focusing on programs aimed at increasing the number of diverse and highly qualified medical professionals ready to introduce effective and innovative approaches to reduce or eliminate health disparities. These programs will improve information resources, clinical education, curricula, research, and cultural competence as they relate to minority health issues and social determinants of health. The year’s summit was a great success! Copyright © 2022 Dongarwar et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Predictors of COVID-19 Vaccine Acceptability among Patients Living with HIV in Northern Nigeria: A Mixed Methods Study.

BACKGROUND: People living with HIV (PLHIV) are at increased risk of COVID-19 acquisition, severe disease, and poor outcomes. Yet, little is known about COVID-19 vaccine hesitancy among PLHIV in high HIV burden countries, such as Nigeria. OBJECTIVE: This study aims to assess the acceptability of the COVID-19 vaccine and identify predictors and reasons for vaccine hesitancy among patients living with HIV and attending a tertiary hospital in Kano, northern Nigeria. METHODS: Using a mixed-methods design, structured questionnaires were administered to a clinic- based sample of patients living with HIV (n = 344), followed by 20 in-depth interviews with a sub-sample. Logistic regression and the framework approach were used to analyze the data. RESULTS: Less than half (46.2 %, n = 159) of the respondents were willing to take the COVID-19 vaccine. Vaccine acceptance was higher among non-Muslim PLHIV (Adjusted Odds Ratio (aOR) = 1.26, 95 % Confidence Interval (95 % CI): 1.10-4.00), persons with high-risk perception (aOR = 2.43, 95 % CI:1.18-5.00), those who were not worried about infertility-related rumors (aOR = 13.54, 95 % CI:7.07-25.94) and persons who perceived antiretroviral drugs are protective against COVID-19 (aOR = 2.76, 95 % CI: 1.48-5.14). In contrast, vaccine acceptance was lower among persons who were not concerned about the potential effects of COVID-19-HIV co-infection (aOR = 0.20, 95 % CI:0.10-0.39). The most common reasons for vaccine hesitancy included doubts about the existence of COVID-19, low-risk perception, anxiety about antiretroviral treatmentvaccine interactions, safety concerns, and infertility-related rumors. CONCLUSION: Covid-19 vaccine acceptance was low among PLHIV. COVID-19 vaccine acceptance was associated with respondents' faith, risk perception, perception of the protective effects of antiretroviral treatment, concerns about COVID-19-HIV co-infection, and infertility-related rumors. Vaccination counseling should be integrated into HIV treatment services to improve COVID-19 vaccine uptake among PLHIV in Kano, Nigeria and similar settings.

'Why Should I Take the COVID-19 Vaccine after Recovering from the Disease?' A Mixed-methods Study of Correlates of COVID-19 Vaccine Acceptability among Health Workers in Northern Nigeria.

We assessed the acceptability of COVID-19 vaccine, predictors, and reasons for vaccine hesitancy among clinical and non-clinical staff at a tertiary hospital in Kano, northern Nigeria.Using a mixed-methods design, structured questionnaires were administered to 284 hospital staff, followed by 20 in-depth interviews with a purposive sub-sample. Logistic regression and the framework approach were used to analyze the data.Only 24.3% (n = 69) of the respondents were willing to accept the COVID-19 vaccine. Acceptance was lower among females (Adjusted Odds Ratio (aOR) = 0.37, 95% Confidence Interval (95%CI): 0.18-0.77 (male vs. female), nurses/midwives (aOR = 0.41, 95%CI:0.13-0.60, physicians vs. nurses/midwives), persons not tested for COVID-19 (aOR = 0.32, 95%CI 0.13-0.79) (no vs. yes) and those who perceived themselves to be at low risk of COVID-19 (aOR = 0.47, 95%CI,0.21-0.89, low vs. high). In contrast, vaccine acceptance was higher among more experienced workers (aOR = 2.28, 95%CI:1.16-8.55, ≥10 vs. <5 years). Vaccine acceptance was also higher among persons who did not worry about vaccine efficacy (aOR = 2.35, 95%CI:1.18-6.54, no vs. yes), or about vaccine safety (aOR = 1.76, 95%CI: 1.16-5.09, no vs. yes), side effects (aOR = 1.85, 95%CI:1.17-5.04, no vs. yes), or rumors (aOR = 2.55, 95%CI:1.25-5.20, no vs. yes). The top four reasons for vaccine hesitancy included distrust, inadequate information, fear of long-term effects, and infertility-related rumors.Concerted efforts are required to build COVID-19 vaccine confidence among health workers in Kano, Nigeria.Our findings can help guide implementation of COVID-19 vaccination in similar settings.

Fourth Annual Summer Research Summit on Health Equity Organized by the Center of Excellence in Health Equity, Training and Research, Baylor College of Medicine, Houston, Texas 77030, USA on May 20, 2021

: Strengthening Our Commitment to Racial and Social Justice to Improve Public Health The fourth annual summer research summit organized by the Center of Excellence (COE) in Health Equity, Training and Research, Baylor College of Medicine (BCM) was held on May 20, 2021. The theme of this year’s summit was ‘Strengthening Our Commitment to Racial and Social Justice to Improve Public Health.’ Given the ongoing pandemic, the summit was conducted virtually through digital platforms. This program was intended for both BCM and external audiences interested in advancing health equity, diversity and inclusion in healthcare among healthcare providers and trainees, biomedical scientists, social workers, nurses, individuals involved in talent acquisition and development such as hiring managers (HR professionals), supervisors, college and hospital affiliate leadership and administrators, as well as diversity and inclusion excellence practitioners. We had attendees from all regions of the United States, India, Pakistan and the Demographic Republic of the Congo. The content in this Book of s encapsulates a summary of the research efforts by the BCM COE scholars (which includes post-baccalaureate students, medical students, clinical fellows and junior faculty from BCM) as well as the external summit participants. The range of topics in this year’s summit was quite diverse encompassing disparities in relation to maternal and child health (MCH), immigrant heath, cancers, vaccination uptakes and COVID-19 infections. Various solutions were ardently presented to address these disparities including community engagement and partnerships, improvement in health literacy and development of novel technologies and therapeutics. With this summit, BCM continues to build on its long history of educational outreach initiatives to promote diversity in medicine by focusing on programs aimed at increasing the number of diverse and highly qualified medical professionals ready to introduce effective and innovative approaches to reduce or eliminate health disparities. These programs will improve information resources, clinical education, curricula, research and cultural competence as they relate to minority health issues and social determinants of health. The summit received very positive response in terms of zealous participation and outstanding evaluations;and overall, it was a great success. Copyright © 2021 Dongarwar et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

"They have produced a vaccine, but we doubt if COVID-19 exists": correlates of COVID-19 vaccine acceptability among adults in Kano, Nigeria.

Vaccination is a critical tool in the global response to the COVID-19 pandemic. Yet, COVID-19 vaccine hesitancy has not been well explored in parts of Nigeria. We assessed the predictors of acceptability of the COVID-19 vaccine and identified reasons for vaccine hesitancy among adults in urban Kano, northern Nigeria. Using a mixed-methods design, we administered structured questionnaires to a cross-section of adults (n = 446), complemented with 20 in-depth interviews. Binary logistic regression and the framework approach were used to analyze the data. About one-half (51.1%, n = 228) of the respondents were willing to take the COVID-19 vaccine. Vaccine acceptance was higher among older respondents (≥30 years) (adjusted Odds Ratio (aOR) = 1.76, 95% Confidence Interval (CI): 1.14-2.99 (≥30 vs. <30), higher-income earners (≥30,000 Naira) (aOR = 2.06, 95%CI:1.12-3.80, ≥30,000 vs. <30,000), and those with a history of a chronic medical disorder (aOR = 1.90, 95%CI:1.06-3.72). Vaccine acceptance was also higher in persons with high risk perception (aOR = 1.61, 95%CI:1.13-2.81, high vs. low), those who were unconcerned about vaccine safety (aOR = 1.71, 95%CI:1.13-3.55), and those who were not worried about efficacy (aOR = 2.02, 95%CI:1.14-4.11) and infertility-related rumors (aOR = 1.98, 95%CI:1.24-3.18). Themes revealed doubts about the existence of COVID-19, mistrust for authorities, and popular credence to rumors and conspiracy theories. In conclusion, COVID-19 vaccine acceptance was sub-optimal and influenced by respondent's age, income, co-morbidities, risk perception, and concerns about vaccine safety, efficacy, and rumors. Context-specific, evidence-based risk communication strategies and trust-building measures could boost vaccine confidence in similar settings.

Predictors of failure of high flow nasal cannula failure in acute hypoxemic respiratory failure due to COVID-19.

Hypoxemic respiratory failure is a common manifestation of COVID-19 pneumonia. Early in the COVID-19 pandemic, patients with hypoxemic respiratory failure were, at times, being intubated earlier than normal; in part because the options of heated humidified high flow nasal cannula (HFNC) and non-invasive ventilation (NIV) were considered potentially inadequate and to increase risk of virus aerosolization. To understand the benefits and factors that predict success and failure of HFNC in this population, we evaluated data from the first 30 sequential patients admitted with COVID-19 pneumonia to our center who were managed with HFNC. We conducted Cox Proportional Hazards regression models to evaluate the factors associated with high flow nasal cannula failure (outcome variable), using time to intubation (censoring variable), while adjusting for comorbidities and immunosuppression. In the majority of our patients (76.7%), the use of HFNC failed and the patients were ultimately placed on mechanical ventilation. Those at increased risk of failure had a higher sequential organ failure assessment score, and at least one comorbidity or history of immunosuppression. Our data suggest that high flow nasal cannula may have a role in some patients with COVID-19 presenting with hypoxemic respiratory failure, but careful patient selection is the likely key to its success.

A Framework for Protecting Pregnant Women in the Era of COVID-19 Pandemic.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent for the coronavirus disease 2019 (COVID-19) pandemic, highlighted and compounded problems while posing new challenges for the pregnant population. Although individual organizations have provided disparate information, guidance, and updates on managing the pregnant population during the current COVID-19 pandemic, it is important to develop a collective model that highlights all the best practices needed to protect the pregnant population during the pandemic. To establish a standard for ensuring safety during the pandemic, we present a framework that describes best practices for the management of the pregnant population during the ongoing COVID-19 pandemic.

COVID 19: Evaluating the Knowledge, Attitude and Preventive Practices of Healthcare Workers in Northern Nigeria.

BACKGROUND: Although much is known about the rapidly spreading COVID-19 disease, a lot of knowledge is still evolving. The knowledge, attitude and practice (KAP) of healthcare workers (HCWs) towards COVID-19 remain key in protecting themselves and in fighting the "war" against the disease. This study assessed the KAP of HCWs in Kano, northern Nigeria. METHODOLOGY: A cross-section of different cadre of healthcare workers was recruited online via google forms. Using a link, the participants completed an adapted from a similar study, pre-tested questionnaire on KAP regarding COVID-19. Predictors of KAP were assessed using logistic regression modelling. RESULTS: Among the 651 HCWs invited to participate, 233 respondents responded giving a response rate of 35.8%. Of these, 195 (83.7%) had good knowledge, 183 (78.9%) had a positive attitude and 180 (77.6%) had good practice towards prevention of COVID-19. The odds of having good knowledge were significantly lower among Community Health Officers/Community Health Extension workers (aOR=0.2, 95% CI: 0.1-0.6;p<0.001) and other health workers compared to doctors. Positive attitude was predicted by good knowledge (aOR=4.8, 95% CI:1.7-010.2;p=0.003), being in the fifth decade of life (aOR=5.5, 95% CI: 1.1-29.3, p=0.04), female gender (aOR=3.0, 95% CI: 1.1-8.3;p=0.04), Christian faith (aOR=7.0, 95% CI: 1.3-40.4; p=0.03), and having a bachelors' or medical degree (aOR=4.6, 95% CI: 1.3-16.5).The only predictor of good practice was good knowledge on COVID-19 (aOR=7.8, 95% CI 2.8-12.4;p<0.001). CONCLUSION AND GLOBAL HEALTH IMPLICATIONS: Majority of the HCWs at the study site have good knowledge, attitude and practice regarding COVID-19. Continuous dissemination of information on prevention of spread of COVID-19 to all HCWs will strengthen the health workforce in the fight against it.

Third Annual Summer Research Summit on Health Equity Organized by the Center of Excellence in Health Equity, Training and Research, Baylor College of Medicine, Houston, Texas 77030, USA on June 9, 2020.

This year's summit was unique given the COVID-19 pandemic: a major global outbreak that has imposed severe restrictions in all aspects of our life. At the outset, we were faced with three mutually exclusive options. First option was to cancel the summit in its entirety: this was the easiest and most obvious choice once the COVID-19 pandemic forced a near total lockdown all over the country with unprecedented disruptions of normal daily activities as the disease announced its thunderous touchdown on United States (US) soil. It was also the most-logical response faced with uncertainty regarding summit logistics and expected poor attendance due to the raging pandemic. Second option was to conduct a digital summit restricted to local audiences at Baylor College of Medicine: this option entailed implementing a virtual summit with attendance restricted to participants from our institution only. It sounded like a reasonable choice but that would impede the presence of diversity of topics, perspectives, insights and experiential learning opportunities, which are what render the summit exciting and worth attending. And finally, the last option was to conduct a digital unrestricted summit open to all interested audiences throughout the US. The conduct of a virtual summit open to all participants from around the country was initially considered daunting given the likelihood of amplified technical problems associated with an array of internet access differentials around the country, which would require a strong Information Technology (IT) presence throughout the sessions. Nonetheless, the attractiveness of going national with a virtual summit, despite the pandemic and logistical challenges, slowly gained converts and became the dominant choice. The response and level of participation in this first virtual summit showed an unanticipated surge despite the increase in registration fees to cover IT costs. This year, we had attendees from all regions of the US as well as from the United Kingdom. The range of topics was quite diverse encompassing health disparities in relation to cancers, nutrition, musculo-skeletal disorders, amputation rates, vaccination uptakes and COVID-19 infections. Various solutions were passionately presented to address these disparities including novel health technologies, community engagement and partnerships, improvement in health literacy and alternative therapeutics. There were no hitches despite the complex breakout sessions, and above all, attendees were satisfied and offered outstanding evaluation scores. This was definitely a summit that metamorphosed from pessimism to a triumphant success! Copyright © 2020 Salihu et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.

SCOR: A secure international informatics infrastructure to investigate COVID-19.

Global pandemics call for large and diverse healthcare data to study various risk factors, treatment options, and disease progression patterns. Despite the enormous efforts of many large data consortium initiatives, scientific community still lacks a secure and privacy-preserving infrastructure to support auditable data sharing and facilitate automated and legally compliant federated analysis on an international scale. Existing health informatics systems do not incorporate the latest progress in modern security and federated machine learning algorithms, which are poised to offer solutions. An international group of passionate researchers came together with a joint mission to solve the problem with our finest models and tools. The SCOR Consortium has developed a ready-to-deploy secure infrastructure using world-class privacy and security technologies to reconcile the privacy/utility conflicts. We hope our effort will make a change and accelerate research in future pandemics with broad and diverse samples on an international scale.

Using Nominal Group Technique to Elucidate a COVID-19 Research Agenda for Maternal and Child Health (MCH) Populations.

As the global impact of the COVID-19 pandemic continues to evolve, robust data describing its effect on maternal and child health (MCH) remains limited. The aim of this study was to elucidate an agenda for COVID-19 research with particular focus on its impact within MCH populations. This was achieved using the Nominal Group Technique through which researchers identified and ranked 12 research topics across various disciplines relating to MCH in the setting of COVID-19. Proposed research topics included vaccine development, genomics, and artificial intelligence among others. The proposed research priorities could serve as a template for a vigorous COVID-19 research agenda by the NIH and other national funding agencies in the US.

COVID-19 Devastation of African American Families: Impact on Mental Health and the Consequence of Systemic Racism.

African Americans are bearing a disproportionate burden of morbidity and mortality due to COVID-19 pandemic. To our knowledge, no previous study has delineated inequities potentially incentivized by systemic racism, and whether synergistic effects impose an abnormally high burden of social determinants of mental health on African American families in the era of COVID-19 pandemic. We applied the social ecological model (SEM) to portray inequities induced by systemic racism that impact the mental health of African American families. In our model, we identified systemic racism to be the primary operator of mental health disparity, which disproportionately affects African American families at all levels of the SEM. Programs tailored towards reducing the disproportionate detrimental effects of COVID-19 on the mental health of African Americans need to be culturally appropriate and consider the nuances of systemic racism, discrimination, and other institutionalized biases.

Expected Surge in Maternal Mortality and Severe Morbidity among African-Americans in the Era of COVID-19 Pandemic.

Prior to the COVID-19 pandemic, African-American mothers were three times as likely to die from pregnancy-related causes compared to white mothers. The impact of the pandemic among African-Americans could further worsen the racial disparities in maternal mortality (MM) and severe maternal morbidity (SMM). This study aimed to create a theoretical framework delineating the contributors to an expected rise in maternal mortality (MM) and severe maternal morbidity (SMM) among African-Americans in the era of the COVID-19 pandemic due to preliminary studies suggesting heightened vulnerability of African-Americans to the virus as well as its adverse health effects. Rapid searches were conducted in PubMed and Google to identify published articles on the health determinants of MM and SMM that have been or likely to be disproportionately affected by the pandemic in African-Americans. We identified socioeconomic and health trends determinants that may contribute to future adverse maternal health outcomes. There is a need to intensify advocacy, implement culturally acceptable programs, and formulate policies to address social determinants of health.

COVID-19 and Child Vaccination: A Systematic Approach to Closing the Immunization Gap.

The COVID-19 pandemic threatens to set back major successes that have been achieved in global vaccine initiatives. We conducted a rapid review and synthesis of the literature on immunization provision and Utilization since the onset of the COVID-19 pandemic. A total of 11 papers comprising peer-reviewed articles and key policies and guidelines, published between January 1 and June 15, 2020, were analyzed. Widespread disruptions of routine immunization and vaccination campaigns were reported leaving millions of children worldwide at risk of measles outbreaks. We present an expanded model of the World Health Organization's Global Routine Immunization Strategic Plan (GRISP) action areas as a tool to help countries quickly adapt to immunization challenges in the presence of COVID-19 and close the emerging immunization coverage gaps.

Covid-19 and Neuro-Behavioral Economics: A Conceptual Framework to Improve Physical and Mental Health among Remote Workers.

Long-term home confinement during the ongoing COVID-19 can have negative mental and physical health consequences, which in turn can reduce productivity among those working remotely. We sought to delineate factors related to neuro-behavioral economics that employers should consider for their employees who are teleworking during the current Covid-19 pandemic. Physical and mental well-being are intertwined and are strongly correlated to high productivity at workplace. By integrating the factors of neuro-behavioral economics into the work culture, companies will alleviate work-related stress leading to improved mental and physical functioning; thus leading to increased productivity.