Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 281
Filter
Add filters

Document Type
Year range
1.
BMC Public Health ; 22(1): 11, 2022 01 05.
Article in English | MEDLINE | ID: covidwho-1606977

ABSTRACT

BACKGROUND: Medicines and vaccines supply chains represent critical systems for realising one of the major targets of the United Nations' third Sustainable Development Goals (SDGs)-access to safe, effective, quality, and affordable essential medicines and vaccines, for all. However, evidence suggests the system is confronted with several challenges in many low-medium income countries, including Nigeria. This scoping review aims to summarize the available evidence on the challenges of medicines and vaccines supply chain system in Nigeria. RESULTS: We searched relevant databases including Scopus and Web of Science for studies published between January 2005 and August 2020 on the challenges associated with medicines and vaccines supply chain systems in Nigeria. Our findings implicate several factors including difficulty with medicines or vaccines selection, procurement, distribution, and inventory management. Others included poor storage infrastructure, financial constraints, insecurity, transportation challenges, inadequate human resources, weak, or poorly implemented policies. These challenges mostly resulted in stock-outs of essential medicines which notably got worsened during the current COVID-19 pandemic. CONCLUSION: Our study is a wake-up call on the need to prioritise the critical sector of the supply chain systems for medicines and vaccines in Nigeria. Effective implementation of existing policies, improved security, strengthening of the health system through adequate budgetary allocations, and provision of infrastructure including regular availability of electricity are keys to surmounting the challenges and improving access to medicines or vaccines in Nigeria.


Subject(s)
COVID-19 , Vaccines , Humans , Nigeria , Pandemics , SARS-CoV-2
2.
Glob Health Sci Pract ; 9(4): 978-989, 2021 12 31.
Article in English | MEDLINE | ID: covidwho-1594125

ABSTRACT

INTRODUCTION: Faced with the coronavirus disease (COVID-19) pandemic, governments worldwide instituted lockdowns to curtail virus spread. Health facility closures and travel restrictions disrupted access to antiretroviral (ARV) therapy for people living with HIV. This report describes how HIV programs in Indonesia, Laos, Nepal, and Nigeria supported treatment continuation by introducing home delivery of ARVs. METHODS: Staff supporting the programs provided accounts of when and how decisions were taken to support ARV home delivery. They captured programmatic information about home delivery implementation using an intervention documentation tool. The 4 country experiences revealed lessons learned about factors favoring successful expansion of ARV home delivery. RESULTS: Three of the countries relied on existing networks of community health workers for ARV delivery; the fourth country, Indonesia, relied on a private sector courier service. Across the 4 countries, between 19% and 51% of eligible clients were served by home delivery. The experiences showed that ARV home delivery is feasible and acceptable to health service providers, clients, and other stakeholders. Essential to success was rapid mobilization of stakeholders who led the design of the home delivery mechanisms and provided leadership support of the service innovations. Timely service adaptation was made possible by pre-existing differentiated models of care supportive of community-based ARV provision by outreach workers. Home delivery models prioritized protection of client confidentiality and prevention measures for COVID-19. Sustainability of the innovation depends on reinforcement of the commodity management infrastructure and investment in financing mechanisms. CONCLUSION: Home delivery of ARVs is a feasible client-centered approach to be included among the options for decentralized drug distribution. It serves as a measure for expanding access to care both when access to health services is disrupted and under routine circumstances.


Subject(s)
COVID-19 , HIV Infections , Pharmaceutical Preparations , Communicable Disease Control , HIV Infections/drug therapy , Humans , Indonesia , Laos , Nepal , Nigeria , SARS-CoV-2
3.
PLoS One ; 16(11): e0259631, 2021.
Article in English | MEDLINE | ID: covidwho-1581790

ABSTRACT

The COVID-19 pandemic has affected all dimensions of lives and has become a social problem as it continues to spread widely through the continuous interactions of people in public spaces where they earn a living. Curbing the spread of COVID-19 requires restrictions in these public spaces, however, the compliance to these measures depends largely on the understanding and interpretations of COVID 19 by users of these public spaces. This study examined the contextual interpretations of public space users about COVID-19 prevention in Ibadan Metropolis, Oyo State. The study was a rapid ethnographic survey in selected public spaces (markets and commercial motor parks) in Ibadan metropolis. Data were collected through participant observation, key informant interviews (3 females; 3 males) and in-depth interviews (30) with, traders, head porters, clients/buyers and commercial vehicle drivers in these public spaces. Interviews conducted were transcribed, sorted into themes using Atlas-ti 7.5.7 and subjected to interpretive-content analysis. Findings revealed that some respondents felt COVID-19 was brought into Nigeria by rich frequent global voyagers, others felt it was through "uncultured" sexual life or wrath of God. Some also doubted the existence of the disease and many of the respondents perceived COVID-19 as a disease reported by the government or a political propaganda to siphon funds. The users of the public spaces in Ibadan Metropolis have variegated perception about the existence and severity of this rapidly spreading virus and this has grave implications for COVID-19 control in the State. Thus, regular interaction with public space users are essential for control efforts.


Subject(s)
COVID-19/epidemiology , Pandemics , SARS-CoV-2/pathogenicity , Adult , Aged , Aged, 80 and over , COVID-19/psychology , COVID-19/virology , Female , Government , Health Knowledge, Attitudes, Practice , Humans , Male , Middle Aged , Nigeria/epidemiology , Surveys and Questionnaires
4.
BMJ Open ; 11(12): e055159, 2021 12 15.
Article in English | MEDLINE | ID: covidwho-1583094

ABSTRACT

OBJECTIVES: To estimate the willingness to accept a COVID-19 vaccine in six sub-Saharan African countries and identify differences in acceptance across countries and population groups. DESIGN: Cross-country comparable, descriptive study based on a longitudinal survey. SETTING: Six national surveys from countries representing 38% of the sub-Saharan African population (Burkina Faso, Ethiopia, Malawi, Mali, Nigeria and Uganda). PARTICIPANTS: Respondents of national high-frequency phone surveys, aged 15 years and older, drawn from a nationally representative sample of households. MAIN OUTCOME MEASURES: Willingness to get vaccinated against COVID-19 if an approved vaccine is provided now and for free, disaggregated by demographic attributes and socioeconomic factors obtained from national household surveys. Correlates of and reasons for vaccine hesitancy. RESULTS: Acceptance rates in the six sub-Saharan African countries studied are generally high, with at least four in five people willing to be vaccinated in all but one country. Vaccine acceptance ranges from nearly universal in Ethiopia (97.9%, 95% CI 97.2% to 98.6%) to below what would likely be required for herd immunity in Mali (64.5%, 95% CI 61.3% to 67.8%). We find little evidence for systematic differences in vaccine hesitancy by sex or age but some clusters of hesitancy in urban areas, among the better educated, and in richer households. Safety concerns about the vaccine in general and its side effects specifically emerge as the primary reservations toward a COVID-19 vaccine across countries. CONCLUSIONS: Our findings suggest that inadequate demand is unlikely to represent the key bottleneck to reaching high COVID-19 vaccine coverage in sub-Saharan Africa. To turn intent into effective demand, targeted information, sensitisation and engagement campaigns bolstering confidence in the safety of approved vaccines and reducing concerns about side effects will be crucial to safeguard the swift progression of vaccine rollout in one of the world's poorest regions.


Subject(s)
COVID-19 Vaccines , COVID-19 , Humans , Nigeria , SARS-CoV-2
5.
PLoS Negl Trop Dis ; 15(12): e0009904, 2021 12.
Article in English | MEDLINE | ID: covidwho-1581900

ABSTRACT

Since its early spread in early 2020, the disease caused by the novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Coronavirus Disease 2019 (COVID-19) has caused mass disruptions to health services. These have included interruptions to programs that aimed to prevent, control, and eliminate neglected tropical diseases (NTDs). In March 2020, the World Health Organization (WHO) released interim guidelines recommending the temporary cessation of mass drug administration (MDA), community-based surveys, and case detection, while encouraging continuation of morbidity management and vector control where possible. Over the course of the following months, national programs and implementing partners contributed to COVID-19 response efforts, while also beginning to plan for resumption of NTD control activities. To understand the challenges, opportunities, and recommendations for maximizing continuity of disease control during public health emergencies, we sought perspectives from Nigeria and Guinea on the process of restarting NTD control efforts during the COVID-19 pandemic. Through semistructured interviews with individuals involved with NTD control at the local and national levels, we identified key themes and common perspectives between the 2 countries, as well as observations that were specific to each. Overall, interviewees stressed the challenges posed by COVID-19 interruptions, particularly with respect to delays to activities and related knock-on impacts, such as drug expiry and prolonged elimination timelines, as well as concerns related to funding. However, respondents in both countries also highlighted the benefits of a formal risk assessment approach, particularly in terms of encouraging information sharing and increasing coordination and advocacy. Recommendations included ensuring greater availability of historical data to allow better monitoring of how future emergencies affect NTD control progress; continuing to use risk assessment approaches in the future; and identifying mechanisms for sharing lessons learned and innovations between countries as a means of advancing postpandemic health systems and disease control capacity strengthening.


Subject(s)
COVID-19 , Communicable Disease Control/organization & administration , Neglected Diseases/prevention & control , Communicable Disease Control/economics , Government Programs/economics , Government Programs/organization & administration , Guinea , Humans , Mass Drug Administration , Nigeria , SARS-CoV-2 , Tropical Medicine/methods
6.
PLoS One ; 16(12): e0260823, 2021.
Article in English | MEDLINE | ID: covidwho-1581770

ABSTRACT

INTRODUCTION: While there has been considerable analysis of the health and economic effects of COVID-19 in the Global North, representative data on the distribution and depth of social and economic impacts in Africa has been more limited. METHODS: We analyze household data collected prior to the COVID-19 pandemic and during the first wave of COVID in four African countries. We evaluate the short-term changes to household economic status and assess women's access to health care during the first wave of COVID-19 in nationally representative samples of women aged 15-49 in Kenya and Burkina Faso, and in sub-nationally representative samples of women aged 15-49 in Kinshasa, Democratic Republic of Congo and Lagos, Nigeria. We examine prevalence and distribution of household income loss, food insecurity, and access to health care during the COVID-19 lockdowns across residence and pre-pandemic wealth categories. We then regress pre-pandemic individual and household sociodemographic characteristics on the three outcomes. RESULTS: In three out of four samples, over 90% of women reported partial or complete loss of household income since the beginning of the coronavirus restrictions. Prevalence of food insecurity ranged from 17.0% (95% CI 13.6-20.9) to 39.8% (95% CI 36.0-43.7), and the majority of women in food insecure households reported increases in food insecurity during the COVID-19 restriction period. In contrast, we did not find significant barriers to accessing health care during COVID restrictions. Between 78·3% and 94·0% of women who needed health care were able successfully access it. When we examined pre-pandemic sociodemographic correlates of the outcomes, we found that the income shock of COVID-19 was substantial and distributed similarly across wealth groups, but food insecurity was concentrated among poorer households. Contrary to a-priori expectations, we find little evidence of women experiencing barriers to health care, but there is significant need for food support.


Subject(s)
COVID-19 , Communicable Disease Control , Health Services Accessibility , Income , Nigeria
7.
J Prev Med Hyg ; 62(3): E575-E585, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1573623

ABSTRACT

Introduction: Coronavirus disease (COVID-19) is impacting social, economic and political patterns globally. To contain its spread, Nigeria like many other countries, imposed drastic measures such as lockdown/curfew. Objectives: This study assessed the knowledge, attitude and perception (KAP) about COVID-19 pandemic among members of staff of a university community in Nigeria. University staff members contribute to national development through dissemination of specialized knowledge and skills and guiding the young generation. Methods: A cross-sectional survey using an anonymous, self-designed, online KAP questionnaire was conducted from April 18 to May 31, 2020. The questionnaire consisted of ten knowledge questions regarding the transmission and prevention of COVID-19. The questions on attitude (15) and perception (10) assessed respondents' behaviour towards adherence to government policies and views on government efforts to contain the infection respectively. Results: A total of 125 (teaching) and 102 (non-teaching) staff responded. Approximately 59.1% of the respondents were males. The mean knowledge and positive attitude levels were 70.8% (SD ± 9.6%) and 83.1% (SD ± 13.07 %) respectively. Significant differences in the knowledge mean scores were observed for demographic categories such as educational qualification (p = 0.001), staff work category (p ≤ 0.000), work background (p ≤ 0.000), and type of lockdown (p = 0.027). Most of the respondents (85.3%) opined that COVID-19 was a biological weapon and viewed the lockdown as necessary (81.5%). However, they thought that the Nigerian government was not doing enough to mitigate COVID-19 spread. Conclusions: The perception of COVID-19 in the university community bear implications across public health initiatives, compliance with precautionary behaviour and bilateral relations with foreign nations.


Subject(s)
COVID-19 , Communicable Disease Control , Cross-Sectional Studies , Health Knowledge, Attitudes, Practice , Humans , Male , Nigeria , Pandemics/prevention & control , Perception , SARS-CoV-2 , Surveys and Questionnaires , Universities
9.
BMJ Glob Health ; 6(11)2021 11.
Article in English | MEDLINE | ID: covidwho-1526499

ABSTRACT

BACKGROUND: With reports of surges in COVID-19 case numbers across over 50 countries, country-level epidemiological analysis is required to inform context-appropriate response strategies for containment and mitigation of the outbreak. We aimed to compare the epidemiological features of the first and second waves of COVID-19 in Nigeria. METHODS: We conducted a retrospective analysis of the Surveillance Outbreak Response Management and Analysis System data of the first and second epidemiological waves, which were between 27 February and 24 October 2020, and 25 October 2020 to 3 April 2021, respectively. Descriptive statistical measures including frequencies and percentages, test positivity rate (TPR), cumulative incidence (CI) and case fatality rates (CFRs) were compared. A p value of <0.05 was considered statistically significant. All statistical analyses were carried out in STATA V.13. RESULTS: There were 802 143 tests recorded during the study period (362 550 and 439 593 in the first and second waves, respectively). Of these, 66 121 (18.2%) and 91 644 (20.8%) tested positive in the first and second waves, respectively. There was a 21.3% increase in the number of tests conducted in the second wave with TPR increasing by 14.3%. CI during the first and second waves were 30.3/100 000 and 42.0/100 000 respectively. During the second wave, confirmed COVID-19 cases increased among females and people 30 years old or younger and decreased among urban residents and individuals with travel history within 14 days of sample collection (p value <0.001). Most confirmed cases were asymptomatic at diagnosis during both waves: 74.9% in the first wave; 79.7% in the second wave. CFR decreased during the second wave (0.7%) compared with the first wave (1.8%). CONCLUSION: Nigeria experienced a larger but less severe second wave of COVID-19. Continued implementation of public health and social measures is needed to mitigate the resurgence of another wave.


Subject(s)
COVID-19 , Pandemics , Adult , Female , Humans , Nigeria/epidemiology , Retrospective Studies , SARS-CoV-2
10.
Afr J Prim Health Care Fam Med ; 13(1): e1-e8, 2021 Oct 27.
Article in English | MEDLINE | ID: covidwho-1524284

ABSTRACT

BACKGROUND: Knowledge of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is unfolding. Insights from patient features in different environments are therefore vital to understanding the disease and improving outcomes. AIM: This study aimed to describe patient characteristics associated with symptomatic presentation and duration of hospitalisation in coronavirus disease 2019 (COVID-19) patients managed in Abuja. SETTING: The study was conducted in Abuja, the Federal Capital Territory, Nigeria. METHODS: This was a retrospective study of 201 COVID-19 patients hospitalised in the Asokoro District Hospital COVID-19 Isolation and Treatment Centre between April 2020 and July 2020. Demographic and clinical data were obtained and outcomes assessed were symptom presentation and duration of hospitalisation. RESULTS: Patients' median age was 39.3 years (interquartile range [IQR]: 26-52); 65.7% were male and 33.8% were health workers. Up to 49.2% of the patients were overweight or obese, 68.2% had mild COVID-19 at presentation and the most common symptoms were cough (38.3%) and fever (33.8%). Hypertension (22.9%) and diabetes mellitus (7.5%) were the most common comorbidities. The median duration of hospitalisation was 14.4 days (IQR: 9.5-19). Individuals with secondary and tertiary education had higher percentage symptoms presentation (8.5% and 34%, respectively), whilst a history of daily alcohol intake increased the length of hospital stay by 129.0%. CONCLUSION: Higher educational levels were linked with symptom presentation in COVID-19 patients and that daily alcohol intake was significantly associated with longer hospital stay. These findings highlight the importance of public education on COVID-19 for symptom recognition, early presentation and improved outcomes.


Subject(s)
COVID-19 , Adult , Hospitalization , Humans , Male , Nigeria/epidemiology , Retrospective Studies , SARS-CoV-2
12.
Pan Afr Med J ; 40: 39, 2021.
Article in English | MEDLINE | ID: covidwho-1502776

ABSTRACT

Introduction: as the coronavirus disease 2019 (COVID-19) spreads, sleep problems are expected to increase among healthcare workers. Therefore, we aimed to assess the knowledge of COVID-19, sleep problem and identify sociodemographic factors associated with sleep problems among healthcare workers in a Nigerian neuropsychiatric hospital. Methods: a cross-sectional study was conducted among 200 healthcare workers in a neuropsychiatric hospital using self-administered questionnaires to assess knowledge of COVID-19, sleep problem, social support, and sociodemographic factors that affect sleep. Chi-square test and Spearman's correlation were applied to assess the association between sociodemographic factors and sleep problems. Results: about 23.9% of the healthcare workers reported having a sleep problem. However, there was no association of sleep problems with any sociodemographic factors except age (r=0.26) and social support (r=-0.18). Conclusion: the study offered insight into the occurrence of sleep problems among healthcare workers and suggested a guide for planning interventions targeted at improving the psychological well-being of healthcare workers in the face of current global pandemics.


Subject(s)
COVID-19 , Health Knowledge, Attitudes, Practice , Personnel, Hospital/statistics & numerical data , Sleep Wake Disorders/epidemiology , Adult , Age Factors , Cross-Sectional Studies , Female , Hospitals, Psychiatric , Humans , Male , Nigeria , Personnel, Hospital/psychology , Social Support , Surveys and Questionnaires
13.
PLoS One ; 16(11): e0259398, 2021.
Article in English | MEDLINE | ID: covidwho-1502074

ABSTRACT

The first case of COVID-19 in Nigeria was recorded on February 27, 2020, being an imported case by an Italian expatriate, to the country. Since then, there has been steady increase in the number of cases. However, the number of cases in Nigeria is low in comparison to cases reported by other countries with similar large populations, despite the poor health system prevailing in the country. This has been mainly attributed to the low testing capacity in Nigeria among other factors. Therefore, there is a need for innovative ways to increase the number of persons testing for COVID-19. The aim of the study was to pilot a nasopharyngeal swab self-sample collection model that would help increase COVID-19 testing while ensuring minimal person-to-person contact being experienced at the testing center. 216 participants took part in this study which was carried out at the Nigerian Institute of Medical Research between June and July 2020. Amongst the 216 participants, 174 tested negatives for both self-collected samples and samples collected by Professionals, 30 tested positive for both arms, with discrepancies occurring in 6 samples where the self-collected samples were positive while the ones collected by the professionals were negative. The same occurred in another set of 6 samples with the self-collected samples being negative and the professional-collected sample coming out positive, with a sensitivity of 83.3% and a specificity of 96.7%. The results of the interrater analysis are Kappa = 0.800 (95% CI, 0.690 to 0.910) which implies an outstanding agreement between the two COVID-19 sampling methods. Furthermore, since p< 0.001 Kappa (k) coefficient is statistically different from zero, our findings have shown that self-collected samples can be reliable in the diagnosis of COVID-19.


Subject(s)
COVID-19 Testing/methods , COVID-19/diagnosis , COVID-19/prevention & control , Polymerase Chain Reaction/methods , Telemedicine/methods , Adolescent , Adult , Aged , COVID-19 Testing/statistics & numerical data , Diagnostic Tests, Routine , Female , Humans , Male , Middle Aged , Nigeria/epidemiology , Remote Consultation/methods , Reproducibility of Results , SARS-CoV-2 , Sensitivity and Specificity , Specimen Handling/methods , Young Adult
14.
Niger Postgrad Med J ; 28(3): 149-159, 2021.
Article in English | MEDLINE | ID: covidwho-1497580

ABSTRACT

Background: Within a short duration, coronavirus disease 2019 (COVID-19) spread globally, affecting all facets of life and causing widespread panic. This study set out to assess the perception and practices towards COVID-19 of urban and rural residents in Akwa Ibom State, Nigeria. Materials and Methods: A cross-sectional study design and multistaged sampling technique were used. Data were collected using an interviewer-administered questionnaire between October and December 2020. Scores assessing perception and practices were allocated and graded based on specific stratified demarcations. P < 0.05 was considered statistically significant. Results: A total of 822 individuals from the selected households were interviewed (urban: 401, 48.8%; rural: 421, 51.2%). Majority of respondents urban (99.8%) and rural (97.9%) were aware of COVID-19. Most respondents had low risk-perception of COVID-19 (62.4%), with significantly more rural respondents having low-risk perception (70.6% rural vs. 54.0% urban). The general perception of COVID-19 amongst the respondents was good (79.2%) with no statistically significant difference between urban and rural residents. Most of the participants had good practices towards COVID-19, with significantly higher proportion of urban respondents having good practice (93.8%) compared to their rural counterparts (83.1%). Amongst rural residents, high-risk perception was associated with higher proportion of good practice (93.4%) compared to 84.5% of low-risk perception (P = 0.015). Conclusions: The participants had high level of awareness, low risk perception, good general perception and good practices toward COVID-19. However, urban respondents showed better practices towards COVID-19. More attention should be directed towards improving COVID-19 perception and practices particularly amongst rural residents.


Subject(s)
COVID-19 , Cross-Sectional Studies , Health Knowledge, Attitudes, Practice , Humans , Nigeria , Perception , Rural Population , SARS-CoV-2 , Surveys and Questionnaires
15.
Front Public Health ; 9: 761614, 2021.
Article in English | MEDLINE | ID: covidwho-1497186

ABSTRACT

Objective: The sudden outbreak of COVID-19 has greatly endangered public health and life safety, leading to new changes in people's housing needs. The purpose of this study is to establish design strategies that are suitable for China's Multi-Unit Residential Buildings (MURBs) in the post-pandemic era, and to identify the users' preferences for these strategies. Methods: This study compiles a set of design requirements by means of a literature review and expert interviews. Three hundred ninety-five online and on-site questionnaires, based on the refined Kano model, were distributed to respondents to reveal their preferences for these strategies. The relationship between the different demographic variables, the preferences of design strategies, as well as the housing unit preferences of home-buyers were also verified by means of an actual project. Results: This study summarizes the four dimensions and 26 design strategies of MURBs in China during the post-pandemic era. These strategies are further extracted into 6 highly attractive, 5 high-value-added and 4 critical quality attributes. In terms of demographic variables, males need more social space, and the elderly need less office space and separate bathrooms in the master bedroom. Due to the impact of the epidemic, people with higher education levels are more required to work at home, and the overall demand for a home working environment is also higher. Conclusion: The home-buyers' preference survey reveals that the housing unit designed based on the refined Kano model is more attractive to home-buyers. The proposed approach can help to provide important and customized decisions to design firms, housing developers, and the government for MURBs planning and strategy formulation in the post-pandemic era in China. More in-depth user surveys in other regions and investigations into the cost assessment of these strategies might be further conducted in the future.


Subject(s)
COVID-19 , Pandemics , Aged , China/epidemiology , Female , Humans , Male , Nigeria , SARS-CoV-2
16.
PLoS One ; 16(6): e0253110, 2021.
Article in English | MEDLINE | ID: covidwho-1496435

ABSTRACT

BACKGROUND: The World Health Organization recommends inpatient hospital treatment of young infants up to two months old with any sign of possible serious infection. However, each sign may have a different risk of death. The current study aims to calculate the case fatality ratio for infants with individual or combined signs of possible serious infection, stratified by inpatient or outpatient treatment. METHODS: We analysed data from the African Neonatal Sepsis Trial conducted in five sites in the Democratic Republic of the Congo, Kenya and Nigeria. Trained study nurses classified sick infants as pneumonia (fast breathing in 7-59 days old), severe pneumonia (fast breathing in 0-6 days old), clinical severe infection [severe chest indrawing, high (> = 38°C) or low body temperature (<35.5°C), stopped feeding well, or movement only when stimulated] or critical illness (convulsions, not able to feed at all, or no movement at all), and referred them to a hospital for inpatient treatment. Infants whose caregivers refused referral received outpatient treatment. The case fatality ratio by day 15 was calculated for individual and combined clinical signs and stratified by place of treatment. An infant with signs of clinical severe infection or severe pneumonia was recategorised as having low- (case fatality ratio ≤2%) or moderate- (case fatality ratio >2%) mortality risk. RESULTS: Of 7129 young infants with a possible serious infection, fast breathing (in 7-59 days old) was the most prevalent sign (26%), followed by high body temperature (20%) and severe chest indrawing (19%). Infants with pneumonia had the lowest case fatality ratio (0.2%), followed by severe pneumonia (2.0%), clinical severe infection (2.3%) and critical illness (16.9%). Infants with clinical severe infection had a wide range of case fatality ratios for individual signs (from 0.8% to 11.0%). Infants with pneumonia had similar case fatality ratio for outpatient and inpatient treatment (0.2% vs. 0.3%, p = 0.74). Infants with clinical severe infection or severe pneumonia had a lower case fatality ratio among those who received outpatient treatment compared to inpatient treatment (1.9% vs. 6.5%, p<0.0001). We recategorised infants into low-mortality risk signs (case fatality ratio ≤2%) of clinical severe infection (high body temperature, or severe chest indrawing) or severe pneumonia and moderate-mortality risk signs (case fatality ratio >2%) (stopped feeding well, movement only when stimulated, low body temperature or multiple signs of clinical severe infection). We found that both categories had four times lower case fatality ratio when treated as outpatient than inpatient treatment, i.e., 1.0% vs. 4.0% (p<0.0001) and 5.3% vs. 22.4% (p<0.0001), respectively. In contrast, infants with signs of critical illness had nearly two times higher case fatality ratio when treated as outpatient versus inpatient treatment (21.7% vs. 12.1%, p = 0.097). CONCLUSIONS: The mortality risk differs with clinical signs. Young infants with a possible serious infection can be grouped into those with low-mortality risk signs (high body temperature, or severe chest indrawing or severe pneumonia); moderate-mortality risk signs (stopped feeding well, movement only when stimulated, low body temperature or multiple signs of clinical severe infection), or high-mortality risk signs (signs of critical illness). New treatment strategies that consider differential mortality risks for the place of treatment and duration of inpatient treatment could be developed and evaluated based on these findings. CLINICAL TRIAL REGISTRATION: This trial was registered with the Australian New Zealand Clinical Trials Registry under ID ACTRN 12610000286044.


Subject(s)
Fever/complications , Health Facilities/statistics & numerical data , Hospitalization/statistics & numerical data , Infant Mortality/trends , Infections/mortality , Pneumonia/mortality , Anti-Infective Agents/therapeutic use , Body Temperature , Democratic Republic of the Congo/epidemiology , Female , Humans , Infant , Infant, Newborn , Infections/drug therapy , Infections/epidemiology , Kenya/epidemiology , Male , Nigeria/epidemiology , Pneumonia/drug therapy , Pneumonia/epidemiology
17.
Sci Rep ; 11(1): 21413, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1493222

ABSTRACT

In this study, we proposed a new data-driven hybrid technique by integrating an ensemble empirical mode decomposition (EEMD), an autoregressive integrated moving average (ARIMA), with a nonlinear autoregressive artificial neural network (NARANN), called the EEMD-ARIMA-NARANN model, to perform time series modeling and forecasting based on the COVID-19 prevalence and mortality data from 28 February 2020 to 27 June 2020 in South Africa and Nigeria. By comparing the accuracy level of forecasting measurements with the basic ARIMA and NARANN models, it was shown that this novel data-driven hybrid model did a better job of capturing the dynamic changing trends of the target data than the others used in this work. Our proposed mixture technique can be deemed as a helpful policy-supportive tool to plan and provide medical supplies effectively. The overall confirmed cases and deaths were estimated to reach around 176,570 [95% uncertainty level (UL) 173,607 to 178,476] and 3454 (95% UL 3384 to 3487), respectively, in South Africa, along with 32,136 (95% UL 31,568 to 32,641) and 788 (95% UL 775 to 804) in Nigeria on 12 July 2020 using this data-driven EEMD-ARIMA-NARANN hybrid technique. The contributions of this study include three aspects. First, the proposed hybrid model can better capture the dynamic dependency characteristics compared with the individual models. Second, this new data-driven hybrid model is constructed in a more reasonable way relative to the traditional mixture model. Third, this proposed model may be generalized to estimate the epidemic patterns of COVID-19 in other regions.


Subject(s)
COVID-19/epidemiology , COVID-19/mortality , Models, Statistical , Neural Networks, Computer , Pandemics/prevention & control , SARS-CoV-2 , COVID-19/transmission , COVID-19/virology , Data Accuracy , Forecasting/methods , Humans , Nigeria/epidemiology , Prevalence , South Africa/epidemiology , Uncertainty
18.
Sci Rep ; 11(1): 21108, 2021 10 26.
Article in English | MEDLINE | ID: covidwho-1493205

ABSTRACT

SARS-CoV-2, the virus causing the COVID-19 pandemic emerged in December 2019 in China and raised fears it could overwhelm healthcare systems worldwide. Mutations of the virus are monitored by the GISAID database from which we downloaded sequences from four West African countries Ghana, Gambia, Senegal and Nigeria from February 2020 to April 2020. We subjected the sequences to phylogenetic analysis employing the nextstrain pipeline. We found country-specific patterns of viral variants and supplemented that with data on novel variants from June 2021. Until April 2020, variants carrying the crucial Europe-associated D614G amino acid change were predominantly found in Senegal and Gambia, and combinations of late variants with and early variants without D614G in Ghana and Nigeria. In June 2021 all variants carried the D614G amino acid substitution. Senegal and Gambia exhibited again variants transmitted from Europe (alpha or delta), Ghana a combination of several variants and in Nigeria the original Eta variant. Detailed analysis of distinct samples revealed that some might have circulated latently and some reflect migration routes. The distinct patterns of variants within the West African countries point at their global transmission via air traffic predominantly from Europe and only limited transmission between the West African countries.


Subject(s)
COVID-19/transmission , COVID-19/virology , Computational Biology/methods , Mutation , SARS-CoV-2 , Africa, Western , Biodiversity , China , Europe , Gambia , Genetic Variation , Genome, Viral , Geography , Ghana , Humans , Nigeria , Phylogeny , Senegal , Time Factors
19.
J Int AIDS Soc ; 24 Suppl 6: e25820, 2021 10.
Article in English | MEDLINE | ID: covidwho-1487494

ABSTRACT

INTRODUCTION: The rapid increase in the number of people living with HIV (PLHIV) on antiretroviral therapy (ART) in Akwa Ibom and Cross River states in Nigeria led to overcrowding at clinics. Patients were devolved to receive ART refills through five differentiated service delivery (DSD) models: fast-track (FT), adolescent refill clubs (ARCs), community pharmacy ART refill programs (CPARPs), community ART refill clubs (CARCs) and community ART refill groups (CARGs) designed to meet the needs of different groups of PLHIV. In the context of COVID-19-related travel restrictions, out-of-facility models offered critical mechanisms for continuity of treatment. We compared retention and viral suppression among those devolved to DSD with those who continued standard care at facilities. METHODS: A retrospective cohort study was conducted among patients devolved to DSD from January 2018 to December 2020. Bivariate analyses were conducted to assess differences in retention and viral suppression by socio-demographic characteristics. Kaplan-Meier assessed retention at 3, 6, 9 and 12 months. Differences in proportions were compared using the chi-square test; a p-value of <0.05 was considered significant. RESULTS: A total of 40,800 PLHIV from 84 facilities received ART through the five models: CARC (53%), FT (19.1%), ARC (12.1%), CPARP (10.4%) and CARG (5.4%). Retention rates at 6 months exceeded 96% for all models compared to 94% among those continuing standard care. Among those using DSD, retention rate at 12 months was higher among adults than children (97.8% vs. 96.7%, p = 0.04). No significant sex differences in retention rates were found among those enrolled in DSD. Viral suppression rates among PLHIV served through DSD were significantly higher among adults than children (95.4% vs. 89.2%; p <0.01). Among adults, 95.4% enrolled in DSD were virally suppressed compared to 91.8% of those in standard care (p <0.01). For children, 89.2% enrolled in DSD were virally suppressed compared to 83.2% in standard care (p <0.01). CONCLUSIONS: PLHIV receiving ART through DSD models had retention but higher viral suppression rates compared to those receiving standard care. Expanding DSD during COVID-19 has helped ensure uninterrupted access to ART in Nigeria. Further scale-up is warranted to decongest facilities and improve clinical outcomes.


Subject(s)
Anti-HIV Agents , COVID-19 , HIV Infections , Adolescent , Adult , Anti-HIV Agents/therapeutic use , Child , Female , HIV Infections/drug therapy , HIV Infections/epidemiology , Humans , Male , Nigeria , Pandemics , Retrospective Studies , SARS-CoV-2
20.
J Clin Microbiol ; 59(7): e0051421, 2021 06 18.
Article in English | MEDLINE | ID: covidwho-1486483

ABSTRACT

Accurate SARS-CoV-2 serological assays are critical for COVID-19 serosurveillance. However, previous studies have indicated possible cross-reactivity of these assays, including in areas where malaria is endemic. We tested 213 well-characterized prepandemic samples from Nigeria using two SARS-CoV-2 serological assays, Abbott Architect IgG and Euroimmun NCP IgG assay, both targeting SARS-CoV-2 nucleocapsid protein. To assess antibody binding strength, an avidity assay was performed on these samples and on plasma from SARS-CoV-2 PCR-positive persons. Thirteen (6.1%) of 212 samples run on the Abbott assay and 38 (17.8%) of 213 run on the Euroimmun assay were positive. Anti-Plasmodium IgG levels were significantly higher among false positives for both Abbott and Euroimmun; no association was found with active Plasmodium falciparum infection. An avidity assay using various concentrations of urea wash in the Euroimmun assay reduced loosely bound IgG: of 37 positive/borderline prepandemic samples, 46%, 86%, 89%, and 97% became negative using 2 M, 4 M, 5 M, and 8 M urea washes, respectively. The wash slightly reduced avidity of antibodies from SARS-CoV-2 patients within 28 days of PCR confirmation; thereafter, avidity increased for all urea concentrations except 8 M. This validation found moderate to substantial cross-reactivity on two SARS-CoV-2 serological assays using samples from a setting where malaria is endemic. A simple urea wash appeared to alleviate issues of cross-reactivity.


Subject(s)
COVID-19 , Malaria , Antibodies, Viral , Humans , Malaria/diagnosis , Nigeria , SARS-CoV-2 , Sensitivity and Specificity
SELECTION OF CITATIONS
SEARCH DETAIL
...