Time-to-survival from COVID-19 disease and its associated factors in Osun State, Nigeria.

Introduction This study focused on estimating the probability of survival and the specific time to survival from COVID-19 among patients who had COVID-19 in Osun state, Nigeria. Also, we examined some factors associated with the time to survival among COVID-19 patients in Osun state, Nigeria. Methods The retrospective data of 2596 records of COVID-19 patients in Osun state were analysed in this study. The outcome variable was the "COVID-19 treatment outcome (survived=1, dead=0)". The time date used in the survival analysis was treatment duration (in days). The explanatory variables were demographic characteristics, type of health facility, vaccination status, symptoms, and mode of admission. The descriptive statistics was computed and presented. Kaplan Meier was used to estimate the median time to survival. Bivariate analysis and multivariate analysis were done using the Log-Rank test and Cox regression, respectively. P values were set at P<0.05. Results The mean age was observed to be 40 (SD=17.51) years, ranging from mostly, 2 months to 98 years old. More (56.1%) of the participants were males. Most (99.5%) of them were Nigerians. Only 1.4% were vaccinated. The survival rate from COVID-19 was 98.1% in Osun State. The median time for survival was 14 (IQR= 14- 16) days. COVID-19 reduces as the number of days for being on treatment increases. Unvaccinated (HR=0.93, 95%CI: 0.43-2.03) and those whose vaccination status was unknown (HR=0.52, 95%CI: 0.37-0.74) were less likely to survive COVID-19 diseases. Conclusion The Survival rate was high, the observed median time to survival was 14 days, and the probability of survival reduces as the number of days of being on treatment for COVID-19 increases. Also, gender, vaccination, type of care, and ethnicity were associated with survival time. Similarly, unvaccinated and inpatients were less likely to rapidly survive COVID-19. This study recommends that the COVID-19 vaccine should be encouraged among patients who have the COVID-19 virus. Also, home care may be further explored to assess its effectiveness in caring for COVID-19 patients. In the same vein, COVID-19 data capturing, and databases need strengthening in Nigeria.

Associated Psychological Factors of Viral Load among Self-Isolating Nigerian COVID-19 Patients.

BACKGROUND: Corona virus disease 2019 (COVID-19) is a pandemic that has affected millions of people worldwide. The aim of this study was to explore the psychological factors of viral load among COVID-19 patients who were on self-isolation in Nigeria. METHODS: This is a cross-sectional study involving five hundred and nine self-isolating COVID-19 patients in Osogbo, Nigeria. They completed a socio-demographic questionnaire, Generalized Anxiety Disorder (GAD-7) questionnaire, Patient Health Questionnaire (PHQ-9), Insomnia Severity Index (ISI-7) and Brief Self Rating Scale (BSRS-5). The viral load was inferred from the Cycle threshold (Ct) value. RESULTS: The prevalence of anxiety symptoms, depressive symptoms, insomnia, and suicidal ideation were 40%, 35.6%, 23%, and 7.3%, respectively. The respondents who had high viral load had significantly higher mean scores compared to those with a low viral load on the anxiety, depression, insomnia, psychological symptoms scales, and suicidal ideation item. There was significant negative correlation between Ct values and the study measures. Only psychological distress and suicidal ideation were the variables that were significantly associated with high viral load. CONCLUSION: There is a need to institute measures for mental health surveillance and psychosocial support among Nigerian COVID-19 patients especially during the period of self-isolation.

CONTEXTE: La maladie du virus de la Corona 2019 (COVID-19) est une pandémie qui a touché des millions de personnes dans le monde. Le but de cette étude était d'explorer les facteurs psychologiques de la charge virale chez les patients COVID-19 en auto-isolement au Nigeria. MÉTHODES: Il s'agit d'une étude transversale impliquant cinq cent neuf patients COVID-19 en auto-isolement au à Osogbo, Nigeria. Ils ont complété un questionnaire sociodémographique sur le trouble anxieux généralisé (GAD-7), le questionnaire sur la santé du patient (PHQ-9), l'indice de gravité de l'insomnie (ISI-7) et l'échelle d'auto évaluation brève (BSRS-5). La charge virale a été déduite de la valeur du seuil de cycle (Ct). RÉSULTATS: La prévalence des symptômes d'anxiété, des symptômes dépressifs, de l'insomnie et du suicide et des idées suicidaires était de 40 %, 35,6 %, 23 % et 7,3 %, respectivement. Les répondants ayant une charge virale élevée avaient des scores moyens significativement plus élevés que ceux qui avaient une faible charge virale sur les échelles d'anxiété, de dépression, d'insomnie, les échelles de symptômes psychologiques et l'item d'idéation suicidaire. Il y avait une corrélation négative significative entre les valeurs de Ct et les mesures de l'étude. Seules la détresse psychologique et l'idéation suicidaire étaient les variables significativement associées à une charge virale élevée. RÉSULTATS: La prévalence des symptômes d'anxiété, des symptômes dépressifs, de l'insomnie et du suicide et des idées suicidaires était de 40 %, 35,6 %, 23 % et 7,3 %, respectivement. Les répondants ayant une charge virale élevée avaient des scores moyens significativement plus élevés que ceux qui avaient une faible charge virale sur les échelles d'anxiété, de dépression, d'insomnie, les échelles de symptômes psychologiques et l'item d'idéation suicidaire. Il y avait une corrélation négative significative entre les valeurs de Ct et les mesures de l'étude. Seules la détresse psychologique et l'idéation suicidaire étaient les variables significativement associées à une charge virale élevée. CONCLUSION: Il est nécessaire d'instituer des mesures de surveillance de surveillance de la santé mentale et de soutien psychosocial parmi les patients de COVID-19 au nigéria en particulier pendant la période d'auto-isolement. Mots clés: Corrélats psychologiques, charge virale, COVID-19, virus Corona, SRAS-CoV-2.

Understanding the determinants of climate change adaptation strategies among smallholder maize farmers in South-west, Nigeria.

Climate is one of the most important factors in agricultural productivity, which could directly or indirectly influence productivity since the climate is linked to physiological processes. It is, therefore, essential to understanding the various strategies used by farmers to mitigate the adverse impact of climate change and the factors that influence maize farmers' adoption and intensity of climate change adaptation strategies among smallholder maize farmers in South-west Nigeria. In all, a sample of three hundred and thirty (311) smallholder maize farmers were interviewed. A double-hurdle count data model was employed to estimate the factors influencing farmers' adoption of adaptation strategies while accounting for selection bias with the plugging of inverse mill ratio (IMR) as a regressor. Significant variables such as household size, depreciation ratio, frequency of extension visits, access to extension, and non-farm income were factors influencing the adoption of climate change adaptation strategies among maize farmers. Age of the respondent, age square, household size, farm-based organization (FBO), non-farm income, climate information, access to credit, farmers residing in Osun State (location_Osun), distance to market significantly influenced the intensity of climate change adaptation strategies. This study, therefore, concluded that farm-level policy efforts that aim to improve rural development should focus on farmers' membership in FBO, increase the visits of extension agents, encourage non-farm income and access to climate change information, particularly during the off-cropping season. Policies and investment strategies of the government should be geared towards supporting improved extension service, providing on-farm demonstration training, and disseminating information about climate change adaptation strategies, particularly for smallholder farmers in Nigeria.

Home-based intervention to test and start (HITS) protocol: a cluster-randomized controlled trial to reduce HIV-related mortality in men and HIV incidence in women through increased coverage of HIV treatment.

BACKGROUND: To realize the full benefits of treatment as prevention in many hyperendemic African contexts, there is an urgent need to increase uptake of HIV testing and HIV treatment among men to reduce the rate of HIV transmission to (particularly young) women. This trial aims to evaluate the effect of two interventions - micro-incentives and a tablet-based male-targeted HIV decision support application - on increasing home-based HIV testing and linkage to HIV care among men with the ultimate aim of reducing HIV-related mortality in men and HIV incidence in young women. METHODS/DESIGN: This is a cluster randomized trial of 45 communities (clusters) in a rural area in the uMkhanyakude district of KwaZulu Natal, South Africa (2018-2021). The study is built upon the Africa Health Research Institute (AHRI)'s HIV testing platform, which offers annual home-based rapid HIV testing to individuals aged 15 years and above. In a 2 × 2 factorial design, individuals aged ≥15 years living in the 45 clusters are randomly assigned to one of four arms: i) a financial micro-incentive (food voucher) (n = 8); ii) male-targeted HIV specific decision support (EPIC-HIV) (n = 8); iii) both the micro incentives and male-targeted decision support (n = 8); and iv) standard of care (n = 21). The EPIC-HIV application is developed and delivered via a tablet to encourage HIV testing and linkage to care among men. A mixed method approach is adopted to supplement the randomized control trial and meet the study aims. DISCUSSION: The findings of this trial will provide evidence on the feasibility and causal impact of two interventions - micro-incentives and a male-targeted HIV specific decision support - on uptake of home-based HIV testing, linkage to care, as well as population health outcomes including population viral load, HIV related mortality in men, and HIV incidence in young women (15-30 years of age). TRIAL REGISTRATION: This trial was registered on 28 November 2018 on, identifier https://clinicaltrials.gov/ .

User perspectives on Implanon NXT in South Africa: A survey of 12 public-sector facilities

Abstract: Background. Implanon NXT, a long-acting reversible contraceptive, was introduced in South Africa (SA) in early 2014, aiming to expand the method mix and increase its effectiveness. Initial uptake was high, but has since declined considerably. In these early years after the implant's introduction, it is important to identify reasons for the decline, and remedy gaps in services. Objectives. To determine periods of use, reasons for the use and early removal of the implant Implanon NXT. Methods. In 2016, we recruited 152 women from six clinics in the City of Johannesburg, and six in North West Province, SA. A semistructured interview was administered to 91 women currently using the implant and 61 previous users. We examined user perspectives, factors influencing women's experiences with the implant and reasons for discontinuation. Results. The participants' mean age was 30 years, with only 15% aged <25. Implant uptake was motivated by convenience (less frequent visits required than for short-acting methods) and by favourable views of the method among friends, family and healthcare providers. Only about a quarter of women recalled being counselled pre-insertion about implant effectiveness, and half about side-effects pre-insertion. Among discontinuers, the median time to device removal was 8 months (interquartile range 6 - 12), and this was primarily as a result of side-effects (90%), especially bleeding-pattern changes and headaches. Removals were most common among married and cohabiting women, often ascribed to the effects of bleeding on their sexual relationships. Rumours and misinformation contributed to some removals. Overall, women's experiences with the implant were rated 'good' or 'very good' by 74% of those continuing use, many of whom reported not having experienced any side-effects or that these had diminished over time. Conclusion. Levels of acceptability among continuing users were high, mainly linked to the method's convenience. While early favourable views drove uptake, negative perceptions, if unaddressed, may now undermine services. Deficiencies in counselling around effectiveness and side-effects may extend to contraceptive services more generally. Women require more intensive support when experiencing sideeffects, including effective systematic approaches to ameliorating bleeding and headaches. Implant services could specifically target young women and first-time contraceptive users. These actions together could reverse the persistent decline in implant use in SA.

Uptake and early removals of Implanon NXT in South Africa: Perceptions and attitudes of healthcare workers

Background. The South African (SA) government introduced Implanon NXT, a long-acting subdermal contraceptive implant, in 2014 to expand contraceptive choice. Following an initial high uptake, its use declined considerably amid reports of early removals and frequent side-effects. We examine providers' perceptions of training and attitudes towards Implanon NXT, as well as their views on the causes of early removals and the impact on the implant service. Objective. To assess healthcare providers' perceptions and attitudes towards implant services in SA. Methods. In-depth interviews were conducted with eight nurses providing implant services in public facilities in Gauteng and North West Province. Emerging themes were identified, manually coded and thematically analysed following an interpretivism approach. Results. Nurses lacked confidence in providing implant services effectively, particularly removals, which they ascribed to the brief, cascade-type training received. Nurses generally held negative views towards the method. They also reported that side-effects are the most common reason for early removals ­ particularly irregular bleeding ­ and that men often do not support their partners who use the method. Lastly, it was found that providers require guidance on counselling regarding the method and standardised guidelines on the management of side-effects. Conclusion. Retraining and support of providers are needed to address competency gaps and negative attitudes towards the method. Assessment of providers' readiness to perform removal procedures is also important. Finally, effective plans are necessary to improve implant continuation rates, especially among women whose partners are unsupportive.