Lessons for strengthening childhood immunization in low- and middle-income countries from a successful public-private partnership in rural Nigeria.

BACKGROUND: Immunization is a cost-effective public health strategy to reduce vaccine preventable disease, especially in childhood. METHODS: This paper reports the philosophy, service delivery, achievements and lessons learned from an immunization program in rural Nigeria privately financed via a corporate social responsibility initiative from GlaxoSmithKline Biologicals. RESULTS: The immunization program served the community for a 16-y period extending from 1998 until 2015, resulting in an increase in age-appropriate immunization coverage from 43% to 78%. CONCLUSION: In its success, this immunization program exemplified the importance of early and sustained community engagement, integration of strategies to optimize implementation outcomes and effective team building well before some of these principles were accepted and codified in the literature. The project also underscores the important role that the private sector can bring to achieving critical immunization goals, especially among underserved populations and provides a model for successful public-private partnership.

COVID-19 Pandemic Response: A Primary Care Experience in Northwest Nigeria.

The effectiveness of healthcare systems during this COVID-19 pandemic will largely depend on their resilience in the face of untold challenges. Hence, we share the ongoing experience of the response of a primary care facility to challenges of the increasing number of undifferentiated patient load in the context of rising COVID-19 cases, infrastructural gap, limited personal protective equipment, and the health workforce in a densely populated town.

L'efficacité des systèmes de soins de santé au cours de la pandémie de COVID-19 dépendra en grande partie de leur résistance face à des défis incalculables. Nous partageons donc l'expérience en cours de la réponse d'un établissement de soins primaires aux défis posés par le nombre croissant de patients indifférenciés dans le contexte de l'augmentation des cas de COVID-19, des lacunes infrastructurelles, de l'équipement de protection individuelle limité et du personnel de santé dans une ville densément peuplée. Mots-clés : COVID-19, Résilience du système de santé, Patients ambulatoires, Pandémie, Soins primaires.

Supply-chain factors and antimicrobial stewardship.

Efficient and secure supply chains are vital for effective health services worldwide. In low- and middle-income countries, the accessibility, affordability and availability of essential medicines, including antimicrobials, remain challenging. Ineffective supply chains often cause antimicrobial shortages, leading to inappropriate use of alternative agents and increasing the risk of antimicrobial resistance. Shortages, coupled with insecure supply chains, also encourage the infiltration of substandard and falsified medicines, leading to suboptimal treatment and further promoting antimicrobial resistance. Addressing antimicrobial supply-chain issues should be considered a key component of antimicrobial stewardship programmes. We have explored the link between medicine supply chains and antimicrobial use in seven focus countries: Kenya, Malawi, Nigeria, Sierra Leone, Uganda, United Republic of Tanzania and Zambia. We explored country medicine supply-system structures, national medicine supply-chain policy documents and global study reports. Our aim was to develop evidence-based strategies to enhance the effectiveness and efficiency of the medicine supply chains in supporting antimicrobial stewardship efforts. Better management of medical supply chains involves rational selection, quantification, forecasting, procurement, storage, distribution, use and stock management of antimicrobials. Important supply-chain considerations include pooled procurement networks to ensure consistent pricing of quality-assured antimicrobials, and improved resource utilization and information exchange among relevant stakeholders. We propose adaptable recommendations for integrating medicine supply chains as an essential part of antimicrobial stewardship programmes, with a call for action at the local, regional and national levels in low- and middle-income countries.

Partout dans le monde, les performances des services de santé dépendent de l'efficacité et de la sécurité des chaînes d'approvisionnement. Mais dans les pays à revenu faible et intermédiaire, l'accessibilité et la disponibilité des médicaments à prix abordable, y compris des antimicrobiens, représentent toujours un défi. L'inefficacité des chaînes d'approvisionnement entraîne souvent des pénuries d'antimicrobiens et, par conséquent, un recours à des alternatives inappropriées et une augmentation du risque de résistance aux antimicrobiens. Ces pénuries, alliées à des chaînes d'approvisionnement peu fiables, favorisent également l'introduction de médicaments falsifiés et de qualité inférieure, altérant l'efficacité du traitement et renforçant encore davantage la résistance aux antimicrobiens. Résoudre les problèmes liés aux chaînes d'approvisionnement en antimicrobiens devrait donc figurer parmi les priorités des programmes de gestion des antimicrobiens. Le présent document s'intéresse au lien entre les chaînes d'approvisionnement en médicaments et l'utilisation d'antimicrobiens dans sept pays cibles: le Kenya, le Malawi, le Nigeria, l'Ouganda, la République-Unie de Tanzanie, la Sierra Leone et la Zambie. Pour chacun de ces pays, nous avons examiné les structures du système d'approvisionnement en médicaments, les documents relatifs à la politique d'approvisionnement national et les rapports d'études globaux. Notre objectif consistait à développer des stratégies fondées sur des données factuelles, afin d'améliorer le fonctionnement et l'efficacité des chaînes d'approvisionnement en médicaments et de contribuer ainsi aux efforts de gestion des antimicrobiens. Une meilleure logistique requiert une certaine rationalité dans la sélection, la quantification, la planification, l'approvisionnement, le stockage, la distribution, l'utilisation et la gestion des stocks d'antimicrobiens. Dans ce contexte, plusieurs éléments sont importants tels que les réseaux d'achats groupés, qui assurent la stabilité des prix pour des antimicrobiens de qualité garantie, ou encore l'optimisation des ressources et l'échange d'informations entre les acteurs concernés. Nous formulons des recommandations ajustables en vue de rendre les chaînes d'approvisionnement en médicaments incontournables dans les programmes de gestion des antimicrobiens, avec un appel à agir à l'échelle locale, régionale et nationale dans les pays à revenu faible et intermédiaire.

Unas cadenas de suministro eficientes y seguras son vitales para la eficacia de los servicios sanitarios en todo el mundo. En los países de ingresos bajos y medios, la accesibilidad, asequibilidad y disponibilidad de los medicamentos esenciales, incluidos los antimicrobianos, sigue siendo un reto. Con frecuencia, las cadenas de suministro ineficaces provocan escasez de antimicrobianos, lo que conlleva un uso inadecuado de agentes alternativos y aumenta el riesgo de resistencia a los antimicrobianos. La escasez, sumada a la inseguridad de las cadenas de suministro, también favorece la infiltración de medicamentos de calidad inferior y adulterados, lo que conduce a un tratamiento subóptimo y fomenta aún más la resistencia a los antimicrobianos. Abordar los problemas de la cadena de suministro de antimicrobianos se debería considerar un componente clave de los programas de administración de antimicrobianos. Hemos explorado la relación entre las cadenas de suministro de medicamentos y el uso de antimicrobianos en siete países seleccionados: Kenia, Malawi, Nigeria, Sierra Leona, Uganda, República Unida de Tanzania y Zambia. Exploramos las estructuras de los sistemas de suministro de medicamentos de los países, los documentos de política nacional sobre la cadena de suministro de medicamentos y los informes de estudios globales. Nuestro objetivo era desarrollar estrategias basadas en evidencias para mejorar la eficacia y la eficiencia de las cadenas de suministro de medicamentos en apoyo de los esfuerzos de administración antimicrobiana. Una mejor gestión de las cadenas de suministro de medicamentos implica la selección racional, la cuantificación, la previsión, la adquisición, el almacenamiento, la distribución, el uso y la gestión de las existencias de antimicrobianos. Entre las consideraciones importantes sobre la cadena de suministro se incluyen las redes de adquisición mancomunada para garantizar precios coherentes de antimicrobianos de calidad garantizada y una mejor utilización de los recursos e intercambio de información entre las partes interesadas pertinentes. Proponemos recomendaciones adaptables para integrar las cadenas de suministro de medicamentos como parte esencial de los programas de administración de antimicrobianos, con una llamada a la acción a nivel local, regional y nacional en los países de ingresos bajos y medios.

Detection of SARS-CoV-2 in Terrestrial Animals in Southern Nigeria: Potential Cases of Reverse Zoonosis.

Since SARS-CoV-2 caused the COVID-19 pandemic, records have suggested the occurrence of reverse zoonosis of pets and farm animals in contact with SARS-CoV-2-positive humans in the Occident. However, there is little information on the spread of the virus among animals in contact with humans in Africa. Therefore, this study aimed to investigate the occurrence of SARS-CoV-2 in various animals in Nigeria. Overall, 791 animals from Ebonyi, Ogun, Ondo, and Oyo States, Nigeria were screened for SARS-CoV-2 using RT-qPCR (n = 364) and IgG ELISA (n = 654). SARS-CoV-2 positivity rates were 45.9% (RT-qPCR) and 1.4% (ELISA). SARS-CoV-2 RNA was detected in almost all animal taxa and sampling locations except Oyo State. SARS-CoV-2 IgGs were detected only in goats from Ebonyi and pigs from Ogun States. Overall, SARS-CoV-2 infectivity rates were higher in 2021 than in 2022. Our study highlights the ability of the virus to infect various animals. It presents the first report of natural SARS-CoV-2 infection in poultry, pigs, domestic ruminants, and lizards. The close human-animal interactions in these settings suggest ongoing reverse zoonosis, highlighting the role of behavioral factors of transmission and the potential for SARS-CoV-2 to spread among animals. These underscore the importance of continuous monitoring to detect and intervene in any eventual upsurge.

Unintended consequences of implementing non-pharmaceutical interventions for the COVID-19 response in Africa: experiences from DRC, Nigeria, Senegal, and Uganda.

INTRODUCTION: The coronavirus (COVID 19) pandemic is one of the most terrifying disasters of the twenty-first century. The non-pharmaceutical interventions (NPIs) implemented to control the spread of the disease had numerous positive consequences. However, there were also unintended consequences-positively or negatively related to the nature of the interventions, the target, the level and duration of implementation. This article describes the unintended economic, Psychosocial and environmental consequences of NPIs in four African countries. METHODS: We conducted a mixed-methods study in the Democratic Republic of Congo (DRC), Nigeria, Senegal and Uganda. A comprehensive conceptual framework, supported by a clear theory of change was adopted to encompass both systemic and non-systemic interventions. The data collection approaches included: (i) review of literature; (ii) analysis of secondary data for selected indicators; and (ii) key informant interviews with policy makers, civil society, local leaders, and law enforcement staff. The results were synthesized around thematic areas. RESULTS: Over the first six to nine months of the pandemic, NPIs especially lockdowns, travel restrictions, curfews, school closures, and prohibition of mass gathering resulted into both positive and negative unintended consequences cutting across economic, psychological, and environmental platforms. DRC, Nigeria, and Uganda observed reduced crime rates and road traffic accidents, while Uganda also reported reduced air pollution. In addition, hygiene practices have improved through health promotion measures that have been promoted for the response to the pandemic. All countries experienced economic slowdown, job losses heavily impacting women and poor households, increased sexual and gender-based violence, teenage pregnancies, and early marriages, increased poor mental health conditions, increased waste generation with poor disposal, among others. CONCLUSION: Despite achieving pandemic control, the stringent NPIs had several negative and few positive unintended consequences. Governments need to balance the negative and positive consequences of NPIs by anticipating and instituting measures that will support and protect vulnerable groups especially the poor, the elderly, women, and children. Noticeable efforts, including measures to avoid forced into marriage, increasing inequities, economic support to urban poor; those living with disabilities, migrant workers, and refugees, had been conducted to mitigate the negative effects of the NIPs.

Mpox in Nigeria: Perceptions and knowledge of the disease among critical stakeholders-Global public health consequences.

BACKGROUND: The mpox (monkeypox) disease is a re-emerging viral zoonosis of international concern that is endemic in parts of Africa. The mpox virus (MPXV), which was hitherto largely limited to some Central and West African countries, was declared a public health emergency of international concern by the WHO on July 23, 2022 following the rapid spread of the virus to non-endemic countries. Globally, as of March 16, 2023, the WHO had reported 86,496 laboratory-confirmed cases of mpox and 111 deaths in 110 countries. Of the 1,420 cases of mpox reported in Africa as of March 16, 2023, Nigeria alone recorded 57.1% (812) of the confirmed cases and eight fatalities recorded in the continent. To help improve on the understanding of the current situation in Nigeria, the present study assessed the perception and knowledge of mpox among Nigerian healthcare workers, academics and tertiary students. The study also sought to highlight the global public health significance of the MPXV, and recommend a One Health approach to limit exporting of the virus beyond the borders of Nigeria. METHODS: A web-based cross-sectional survey was conducted between 24 July 2022 and 12 August 2022 to evaluate the perception and knowledge of mpox among 1544 Nigerians, consisted of healthcare workers (n = 832), academics (n = 306) and tertiary students (n = 462). Data on the respondents' socio demographics and their information sources on mpox were also collected. Each correct response was allotted one point while an incorrect response was scored zero. The scores for perception and knowledge were dichotomized into positive (>5.5) and negative (≤5.5) and adequate (>5.8) and inadequate (≤5.8), respectively; using the average scores for perception and knowledge. The average score for perception and knowledge were summarised and presented as the mean and standard deviation (SD). Chi-square tests of association and binary logistic regression were carried out to determine factors associated with the outcome variables. RESULTS: Of the 1452 respondents that had heard of mpox, 878 (60.5%) and 419 (28.9%) had adequate knowledge and positive perception concerning MPXV infection respectively. Average perception score was 5.5. Mean perception and knowledge scores were 4.5(SD: 2.0) and 5.8 (SD: 1.9), respectively. Factors that were significantly associated with knowledge level were age (p = 0.020) educational qualification attained (p = 0.004), occupation (p<0.001), and geopolitical zone of residency (p = 0.001). There was a positive correlation between perception and knowledge scores (r = 0.4, p<0.001). Positive perceptions were likely among respondents who had tertiary education, and residing in North-west Nigeria. Likewise, adequate knowledge scores were likely among respondents under 30 years of age, with tertiary education or reside in North-west Nigeria. Sources of information were significantly associated with perception (p = 0.004) and knowledge (p<0.001) of the respondents. CONCLUSION: The findings of this study show that there is disparity in the knowledge and perception of mpox in the study population, and as a result, there is a need to intensify awareness about MPXV infection to enhance positive perception among the respondents. This has potential to safeguard public health and contain the disease thus preventing it from spreading to the global community. A One Health approach involving animal and human health workers is imperative for improved knowledge and a good perception towards the disease among respondents, and enhanced active surveillance and early detection of MPXV in reservoir hosts (rodents and non-human primates); to prevent reverse zoonotic transmission of the virus at the human-animal interface.

Clinical predictors of Covid-19 mortality in a tertiary hospital in Lagos, Nigeria: A retrospective cohort study.

Background: The predictors of mortality among patients presenting with severe to critical disease in Nigeria are presently unknown. Aim: The aim of this study was to identify the predictors of mortality among patients with COVID-19 presenting for admission in a tertiary referral hospital in Lagos, Nigeria. Patients and Methods: The study was a retrospective study. Patients' sociodemographics, clinical characteristics, comorbidities, complications, treatment outcomes, and hospital duration were documented. Pearson's Chi-square, Fischer's Exact test, or Student's t-test were used to assess the relationship between the variables and mortality. To compare the survival experience across medical comorbidities, Kaplan Meir plots and life tables were used. Univariable and multivariable Cox-proportional hazard analyses were conducted. Results: A total of 734 patients were recruited. Participants' age ranged from five months to 92 years, with a mean ± SD of 47.4 ± 17.2 years, and a male preponderance (58.5% vs. 41.5%). The mortality rate was 9.07 per thousand person-days. About 73.9% (n = 51/69) of the deceased had one or more co-morbidities, compared to 41.6% (252/606) of those discharged. Patients who were older than 50 years, with diabetes mellitus, hypertension, chronic renal illness, and cancer had a statistically significant relationship with mortality. Conclusion: These findings call for a more comprehensive approach to the control of non-communicable diseases, the allocation of sufficient resources for ICU care during outbreaks, an improvement in the quality of health care available to Nigerians, and further research into the relationship between obesity and COVID-19 in Nigerians.

COVID-19 Vaccine Attitude and Its Predictors Among People Living With Chronic Health Conditions in Ibadan, Nigeria.

Objective: To assess vaccination attitude and its associated factors among people with chronic health conditions. Methods: In this cross-sectional study, participants were 423 patients with chronic medical conditions. Data were collected on socio-demographic and COVID-19-related characteristics, via Open Data Kit software. A Vaccination Attitudes Examination (VAX) Scale was adopted. The main outcome was vaccine attitude status defined as positive if a VAX sum score was above the median value; otherwise, non-positive. Data were analysed using Chi-square and multivariate logistic regression analyses, at 5% level of significance. Results: Overall proportion of patients with a positive attitude towards COVID-19 vaccination uptake was 46.6%. The most influential factor towards positive attitude was rating the government high in handling the pandemic. Other factors were education, income, COVID-19 knowledge and living room arrangement (p < 0.05). Conclusion: Less than half of people living with a chronic medical condition had a positive attitude towards the COVID-19 vaccine. The attitudes are strongly mediated by confidence in the government. The government could promote a positive vaccine attitude by improving the clarity of health instructions that shows government transparency and effective communication. These are critical tools for maintaining public trust and confidence.

Radiographers' knowledge, attitude and adherence to standard COVID-19 precautions and the policy implications: a national cross-sectional study in Nigeria.

BACKGROUND: We investigated the knowledge of COVID-19 pathogenesis and prevention, attitude, and adherence to safe clinical practices among radiographers during the pandemic and made some informed policy recommendations. MATERIALS AND METHODS: The study was an online cross-sectional survey. The questionnaire captured data on respondents' demographics, knowledge of COVID-19, attitudes, practices, and standard precaution adherence during the pandemic. Data were analysed using descriptive statistics, Pearson's correlation and one-way ANOVA tests. RESULTS: Of the 255 respondents, 17.3% were actively involved in the management of COVID-19 cases. Participants had high scores regarding their knowledge of COVID-19 pathology (82.46 ± 8.67%), prevention (93.43 ± 7.11%) and attitude (74.11 ± 11.61%), but low compliance to safety precautions (56.08 ± 18.56%). Knowledge about COVID-19 prevention strategies differed significantly across educational qualifications, F(3, 251) = 4.62, p = .004. Similarly, levels of compliance with safety precautions differed across educational qualification (F[3, 251] = 4.53, p = .004) and years-in-practice (F[4, 250] = 4.17, p = .003). CONCLUSION: Participants' adherence to standard COVID-19 precautions was low. The level of professional qualification influenced participants' knowledge and safe practices during the pandemic. Upgrading the aseptic techniques and amenities in practice settings and broadening the infectious diseases modules in the entry-level and continuous professional education may improve radiographers' response to COVID-19 and future pandemics.Key messagesRadiographers whose qualifications were lower than a bachelor's degree had significantly less knowledge of COVID-19 prevention.Generally, radiographers had a positive attitude towards safe practices during the pandemic, but inadequate education, standard operational guidelines and resources affected their level of adherence.Apart from the shortage of personal protective equipment, poor infrastructural design and inadequate hygienic facilities such as handwashing stations, running water and non-contact hand sanitizer dispensers hampered adherence to COVID-19 precautions in low-resource settings.

Coronavirus disease 2019 risk assessment of adults and geospatial mapping in selected communities of Southwest Nigeria.

Background: Coronavirus disease 2019 (COVID-19) remained a worldwide public health problem. Risk assessment and mapping can be deployed to assist in the control and management of disease outbreaks. Aim: The aim of this study was to conduct COVID-19 risk assessment and mapping in selected communities of Southwest Nigeria. Methods: This was a cross-sectional study of adults, 18 years and above, involving the use of multi-stage sampling. Data collection was done with a pre-tested, structured, interviewer-administered questionnaire. The Statistical Package for the Social Sciences version 23 and Environmental Systems Research Institute ArcGIS desktop version 10.5 were used for data analysis and spatial mapping, respectively. The threshold for statistical significance was set at P < 0.05. Results: The respondents' mean age was 40.6 ± 14.5 years. Self-reported vulnerability factors identified included hypertension, diabetes mellitus, working in hospital facility, cigarette smoking and age ≥60 years amongst others. About a quarter (20.2%) had a high risk of COVID-19 following risk quantification. The risk cuts across geographical locations and socio-economic status. Education was significantly associated with COVID-19 risk. The spatial interpolation map revealed that the farther a community was from the high-burden area, the lower the risk of COVID-19. Conclusion: There was a high prevalence of self-reported COVID-19 risk. Identified communities with COVID-19 high-risk burden in the risk mapping and those with stratified proximity to these areas need to be targeted by the government for a public health awareness campaign.

Perceptions and uptake of COVID-19 vaccines amongst undergraduate students in a tertiary institution in Lagos State.

Background: COVID-19 pandemic has ravaged the world, causing deaths in different countries. Fortunately, production of its vaccine has brought some tranquillity, and Nigeria was not left behind. This study aimed to determine the role of knowledge and perception towards the uptake of COVID-19 vaccine amidst undergraduate students of the University of Lagos, Lagos, Nigeria. Methods: This descriptive cross-sectional study was carried out amongst 170 students at the University of Lagos using a multi-stage sampling method. Self-administered questionnaires were used to collect information on demography, knowledge, perception, acceptance and uptake of COVID-19 vaccine. Data were analysed utilising SPSS Version 26. The level of significance was at P < 0.05. Results: Majority of respondents 125 (73.5%) had good knowledge of COVID-19 vaccine and 87 (51.2%) respondents attributed source of information to social media. Although many 99 (58.2%) respondents had positive perceptions of the vaccine, few 16 (9.4%) had taken the vaccine. Less than quarter 24 (22.1%) planned to receive COVID-19 vaccine while majority 120 (77.9%) had no plans to, cite safety concerns. There was a statistically significant association between age (P = 0.001), level of training (P = 0.034) and uptake of COVID-19 vaccine. Conclusion and Recommendations: The level of uptake of COVID-19 vaccine was poor amongst undergraduate students in tertiary institutions in Lagos. Age and level of training of respondents were factors associated with poor uptake. It is recommended that the section of university responsible for sharing of information amongst students organises risk communication activities targeted at specific areas about COVID-19 vaccine to improve vaccine uptake amongst students.

COVID-19 pandemic policing and public (non)compliant behaviour: dataset from Nigeria.

OBJECTIVES: The unprecedented nature of COVID-19 pandemic lockdown order projected to contain the pandemic and the global use of the police to enforce the order has necessitated the investigation of public (non-compliant) behavior and police intervention (misconduct). Given that the phases of easing the lockdown and reopening of the economy were already underway in Nigeria in September 2020, four months post-lockdown, this period was deemed suitable to collect the data. DATA DESCRIPTION: The data consists of 30 participants' (25 individuals and five police personnel) views regarding the reasons that exacerbated the violation and the 'alleged' unethical practices of police personnel while enforcing the lockdown. However, it benefits the broader scientific community in areas such as policing, disaster risk reduction, pandemic management and public administration. It is valuable in police reforms against unethical practices and gives clear policy directions to policymakers and authorities in managing future public health emergencies. Also, it is useful in understanding the public awareness about the pandemic and public (mis)trust and disposition towards the government authorities on the obedience to law and public health safety advisories to contain a pandemic.

Magnet-Retained closed bulb hollow obturator and orbital prosthesis for patient with maxillectomy and orbital exenteration following COVID-Associated mucormycosis.

The rehabilitation of facial deformities is a challenging endeavour that necessitates customising the procedure for each patient. Significant physical and psychological impacts might arise as a result of the deformity in the orofacial region. Post-COVID rhino-orbital mucormycosis has led to rise in extraoral and intraoral defects since 2020. To avoid further surgery, an economical maxillofacial prosthesis is an excellent choice as it is aesthetic, durable, long-lasting and retentive. This case report describes the prosthetic rehabilitation of the patient with post-COVID mucormycosis maxillectomy and orbital exenteration using a magnet-retained closed bulb hollow acrylic obturator and room-temperature vulcanising silicone orbital prosthesis. To enhance retention, a spectacle and medical-grade adhesive were also used.

COVID-19 surveillance in Democratic Republic of Congo, Nigeria, Senegal and Uganda: strengths, weaknesses and key Lessons.

INTRODUCTION: As part of efforts to rapidly identify and care for individuals with COVID-19, trace and quarantine contacts, and monitor disease trends over time, most African countries implemented interventions to strengthen their existing disease surveillance systems. This research describes the strengths, weaknesses and lessons learnt from the COVID-19 surveillance strategies implemented in four African countries to inform the enhancement of surveillance systems for future epidemics on the continent. METHODS: The four countries namely the Democratic Republic of Congo (DRC), Nigeria, Senegal, and Uganda, were selected based on their variability in COVID-19 response and representation of Francophone and Anglophone countries. A mixed-methods observational study was conducted including desk review and key informant interviews, to document best practices, gaps, and innovations in surveillance at the national, sub-national, health facilities, and community levels, and these learnings were synthesized across the countries. RESULTS: Surveillance approaches across countries included - case investigation, contact tracing, community-based, laboratory-based sentinel, serological, telephone hotlines, and genomic sequencing surveillance. As the COVID-19 pandemic progressed, the health systems moved from aggressive testing and contact tracing to detect virus and triage individual contacts into quarantine and confirmed cases, isolation and clinical care. Surveillance, including case definitions, changed from contact tracing of all contacts of confirmed cases to only symptomatic contacts and travelers. All countries reported inadequate staffing, staff capacity gaps and lack of full integration of data sources. All four countries under study improved data management and surveillance capacity by training health workers and increasing resources for laboratories, but the disease burden was under-detected. Decentralizing surveillance to enable swifter implementation of targeted public health measures at the subnational level was a challenge. There were also gaps in genomic and postmortem surveillance including community level sero-prevalence studies, as well as digital technologies to provide more timely and accurate surveillance data. CONCLUSION: All the four countries demonstrated a prompt public health surveillance response and adopted similar approaches to surveillance with some adaptations as the pandemic progresses. There is need for investments to enhance surveillance approaches and systems including decentralizing surveillance to the subnational and community levels, strengthening capabilities for genomic surveillance and use of digital technologies, among others. Investing in health worker capacity, ensuring data quality and availability and improving ability to transmit surveillance data between and across multiple levels of the health care system is also critical. Countries need to take immediate action in strengthening their surveillance systems to better prepare for the next major disease outbreak and pandemic.

COVID-19 Vaccine Hesitancy among Clinical Medical Students in Enugu, South East Nigeria.

BACKGROUND: Clinical medical students are exposed to COVID-19 infection, thus it is imperative to achieve a high COVID-19 vaccination rate among this group of people. OBJECTIVE: To determine the level of acceptance of COVID-19 vaccine and possible reasons for COVID-19 vaccine hesitance among medical students in Enugu, Nigeria. METHODS: A cross-sectional study of 420 medical students at the two university teaching hospitals in Enugu. A p-value of less than .05 was considered statistically significant. RESULTS: Only 36.1% of the respondents were willing to take the COVID-19 vaccine. Extra source of income was significantly associated with the acceptability of the COVID-19 vaccine among the students (p = .012). CONCLUSION: COVID-19 vaccine acceptance rate among medical students in Enugu appears to be very low. There is an urgent need for more advocacy and enlightenment to address the misconceptions and fears fueling the high vaccine hesitance rate seen in the study.

Does where mothers live matter? Regional variations in factors influencing place of child delivery in Nigeria.

Utilization of health care facilities for child delivery is associated with improved maternal and neonatal outcomes, but less than half of mothers use these for child delivery in Nigeria. This study investigated the factors associated with facility delivery in Nigeria, and their variation between the Northern and Southern parts of the country - two regions with distinct socio-cultural make-ups. The study included 33,924 mothers aged 15-49 who had given birth in the last 5 years preceding the 2018 Nigeria Demographic and Health Survey. Overall, higher age, being educated, being a Christian, being an urban resident, being exposed to mass media, making joint decisions with partner on health care, beginning antenatal visits in the first trimester and attending antenatal clinics frequently were found to be associated with improved use of a health care facility for child delivery. An average mother in Northern Nigeria had a 38% chance of having a facility-based delivery, whereas the likelihood in the South was 76%. When other factors were adjusted for, age and listening to the radio were significant predictors of facility-based delivery in the South but not in the North. In the North, Christians were more likely than Muslims to have a facility-based delivery, but the reverse was true in the South. Rural women in the South had a 16% greater chance of having a facility-based delivery than urban women in the North. The study results suggest that there is inequality in access to health care facilities in Nigeria, and the differences in the socio-cultural make-up of the two regions suggest that uniform intervention programmes may not yield similar results across the regions. The findings give credence to, and expand on, the Cosmopolitan-Success and Conservative-Failure Hypothesis.

Psychological Distress, Anxiety, Depression, and Associated Factors Among Nigerian Healthcare Workers During COVID-19 Pandemic: A Cross-Sectional Study.

Objectives: We determined the prevalence of psychological distress, and the associations between sociodemographic factors, anxiety, depression, COVID-19-related experiences, and psychological distress, among nurses and doctors in Nigeria. Methods: The study was a cross-sectional descriptive study, conducted over a month (1st of July-31st of July 2021) among 434 Health Care Workers (HCWs) [225 (51.8%) nurses and 209 (48.2%) doctors] from two tertiary health facilities in southwestern Nigeria. Binary logistic regression was carried out to determine the factors associated with psychological distress (dependent variable), while the independent variables were anxiety, depression, and COVID-19 experience-related factors. Results: The prevalence of moderate and severe psychological distress was 49.1% and 5.8%, respectively. Individuals who had the first degree had significantly lower odds (AOR: 0.43; p = 0.037) of experiencing psychological distress while being a nurse (AOR: 2.03; p = 0.014), higher levels of anxiety (1.28; p < 0.001), and depression (AOR: 1.17; p = 0.005) were associated with significantly higher odds of experiencing moderate to severe levels of psychological distress. Conclusion: There is a high level of psychological distress experienced by these health workers. Hence, they will benefit from strategies to reduce their distress.

Readiness, barriers, and attitude of students towards online medical education amidst COVID-19 pandemic: A study among medical students of Ebonyi State University Abakaliki, Nigeria.

INTRODUCTION: The COVID-19 pandemic caused massive disruption to medical education in Nigeria, necessitating the call for online medical education in the country. This study assessed the readiness, barriers, and attitude of medical students of Ebonyi State University Abakaliki, Nigeria, to online medical education. METHODS: A cross-sectional study design was employed. All matriculated medical students of the university participated in the study. Information was obtained using a pre-tested, semi-structured questionnaire which was self-administered. Good attitude towards information and communication technology (ICT) based medical education was determined by the proportion of respondents correctly answering 60% of nine variables. Readiness for online classes was determined by the proportion of students who preferred either a combination of physical and online lectures or only online medical education amidst the COVID-19 pandemic. Chi-square test and multivariate analysis using binary logistic regression analysis were used in the study. A p-value of <0.05 determined the level of statistical significance. RESULTS: Four hundred and forty-three students participated in the study (response rate; 73.3%). The mean age of the students was 23.0±3.2 years. The majority of the respondents, 52.4%, were males. The students' most preferred sources for studying before the COVID-19 pandemic included textbooks, 55.1% and lecture notes, 19.0%. The commonly visited websites included Google, 75.2%, WhatsApp, 70.0% and YouTube, 59.1%. Less than half, 41.1%, have a functional laptop. The majority, 96.4%, have a functioning email address, while 33.2% participated in a webinar during the COVID-19 pandemic. Though 59.2% had a good attitude towards online medical education, only 56.0% expressed readiness for online medical education. The major barriers to online medical education included poor internet connectivity, 27.1%, poor e-learning infrastructure, 12.9% and students not having laptops, 8.6%. Predictors of readiness for online medical education included previous participation in a webinar, AOR = 2.1, (95%CI: 1.3-3.2) and having a good attitude towards IT-based medical education, AOR = 3.5, (95%CI: 2.3-5.2). CONCLUSIONS: The majority of the students showed readiness for online medical education. Lessons from COVID-19 pandemic necessitate the initiation of online medical education. University authorities should ensure that every enrolled medical student owns or have access to a dedicated laptop through a university-mediated arrangement. Adequate attention should be given to the development of e-learning infrastructure, including steady internet services within the confines of the university.

Outcome of Patients with Common Endocrine Diseases Who Had COVID-19 in two Centers in Lagos, Nigeria: A Cross-Sectional Study.

BACKGROUND: Endocrine diseases are ubiquitous. In our environment, diabetes mellitus (DM), obesity and thyroid disorders represent the most common examples. Diabetes mellitus is a global health problem with a myriad of complications. We sought to evaluate outcome in terms of fatality in those with common endocrine diseases who were infected with COVID-19. AIMS AND OBJECTIVES: To determine outcome in terms of mortality in patients with common endocrine diseases who contracted COVID-19. MATERIALS AND METHODS: We conducted an observational, descriptive, cross-sectional study with 120 participants drawn from the endocrinology/DM clinic at the Lagos University Teaching Hospital and Serenity Hospital, Surulere (a private medical clinic). Data collected included age, gender, type of endocrine disease, comorbid diseases, and COVID-19 status. Through charts from the medical records department, outcome of participants in terms of mortality was determined. RESULTS: Data of 120 subjects were analyzed. There were 61males and 59 females, yielding a male:female ratio of 1:1. Mean age was 58 years and the mode was 46 years. Over half (88) of the patients had diabetes mellitus, 22 had obesity, and 17 had thyroid disorders. The case fatality rate of patients with endocrine diseases who had COVID-19 was 11%, with about 85% of these deaths occurring in the elderly (those aged above 60 years). Ninety-two percent of the patients who died had type 2 DM. Approximately 80% of patients who were infected with COVID-19 had at least one co-morbid disease. CONCLUSION: Older age, type 2 diabetes mellitus, and the presence of at least one comorbidity were associated with increased mortality in patients with endocrine diseases who were infected with COVID-19 in our study.

CONTEXTE: Les maladies endocriniennes sont omniprésentes. Dans notre environnement, le diabète sucré, l'obésité et les troubles thyroïdiens en sont les exemples les plus courants. Le diabète est un problème de santé mondial qui s'accompagne d'une myriade de complications. Nous avons cherché à évaluer l'issue en termes de mortalité chez les personnes atteintes de maladies endocriniennes courantes qui ont été infectées par COVID-19. BUTS ET OBJECTIFS: Déterminer l'issue en termes de mortalité chez les patients atteints de maladies endocriniennes courantes qui ont contracté COVID 19. MATÉRIEL ET MÉTHODOLOGIES: Nous avons mené une étude observationnelle, descriptive et transversale auprès de 120 participants provenant de la clinique d'endocrinologie/DM de l'hôpital universitaire de Lagos et de l'hôpital Serenity, Surulere (clinique médicale privée). Les données recueillies comprenaient l'âge, le sexe, le type de maladie endocrinienne, les maladies concomitantes et le statut COVID-19. Les résultats des participants en termes de mortalité ont été déterminés à partir des dossiers médicaux. RÉSULTATS: Les données de 120 sujets ont été analysées. Il y avait 61 hommes et 59 femmes, avec un ratio homme/femme de 1:1. L'âge moyen était de 58 ans, le mode de 46 ans. Plus de la moitié [88] des patients souffraient de diabète sucré. 22 patients souffraient d'obésité et 17 de troubles thyroïdiens. Le taux de létalité des patients souffrant de maladiesendocriniennes et atteints de COVID-19 était de 11 %, 85 % de ces décès survenant chez des personnes âgées, c'est-à-dire de plus de 60 ans. 92 % des patients décédés souffraient de diabète de type 2. Environ 80 % des patients infectés par COVID-19 présentaient au moins une maladie concomitante. CONCLUSION: L'âge avancé, le diabète de type 2, la présence d'au moins une comorbidité sont associés à une mortalité accrue chez les patients atteints de maladies endocriniennes et infectés par COVID-19 dans notre étude. Mots-clés: Maladies endocriniennes, COVID-19, comorbidités, syndrome métabolique.