Internal displacement; an impediment to the successful implementation of planned measles supplemental activities in Nigeria, a case study of Benue State.

BACKGROUND: Measles is a highly infectious disease with great burden and implication on a displaced population with low immunity status. The disease can cause up to 140,000 deaths annually. Internal displacement during supplemental immunization activities often affects optimal reach and coverage of the campaign as people move and implementation and logistic plans are usually disrupted with attendant missed children. This study documented the process of extension of the measles vaccination campaign (MVC) 2018 for five internally displaced persons (IDPs) camps in Benue state, not previously in the microplan, to increase population herd immunity. METHODS: We obtained population figures and disease surveillance data for five IDPs camps and used it to conduct detailed microplanning to determine the requirement for the conduct of additional days of measles vaccination. Vaccination teams used fixed posts in the camps and temporary posts strategy in designated locations in the host communities. RESULTS: The estimated total population of the IDPs was 170,000 with MVC target population of 9374 which was not earlier planned for. There was reported measles outbreaks in IDP camps in both Guma and Makurdi Local Government areas (LGAs) during period of displacement. Microplans requirement determined 10,421 bundled measles vaccine, 30 health workers, 5 vehicles and 15 motorcycles. A total of 7679 out of 9374 (81.9%) of the eligible children aged 9-59 months were vaccinated during the 3 days of the campaign. CONCLUSION: Non-inclusion of plans on internally displaced population in supplemental immunization activities (SIAs) microplans have a potential risk of vaccine preventable diseases (VPDs) outbreak. Future Measles Vaccination campaigns should take cognizance of internal displacement due to insecurity and other humanitarian emergencies.

Barriers to uptake of prevention of mother-to-child transmission of HIV services among mothers of vertically infected HIV-seropositive infants in Makurdi, Nigeria.

BACKGROUND: Perinatal transmission of human immunodeficiency virus (HIV) continues in Nigeria because of the poor use of prevention of mother-to-child transmission of HIV (PMTCT) services. This study reports on the barriers preventing mothers of vertically infected HIV-seropositive infants to use the PMTCT services at the Federal Medical Centre, Makurdi, Nigeria. METHODS: This is a descriptive study conducted between January and April, 2014. A quantitative survey was applied to detect barriers along the PMTCT services cascade among 52 mothers of vertically infected HIV-seropositive infants. This includes 22 women who attended antenatal care at the Federal Medical Centre (designated as Group A mothers) and 30 women who did not receive any form of PMTCT service (Group B mothers). The study was supplemented with a focused group discussion involving 12 discussants from the two groups. RESULTS: In the quantitative assessment: among the Group A mothers, falling asleep was the most common reason (n=22, 100%) for missing therapeutic/prophylactic antiretroviral medicine; financial constraint (n=22, 100%) was the most common reason for antenatal care visit defaults; and a lot of the mothers (n=11, 50.0%) did not give nevirapine to their newborns because they delivered at home. Among Group B mothers, unawareness of HIV-seropositive status was the most common reason (n=28, 93.3%) given for not accessing PMTCT services. In the qualitative study: noninvolvement of male partners, stigma and discrimination experienced by HIV-seropositive mothers, financial constraints in couples, involvement of traditional birth attendants in antenatal care and delivery of HIV-infected women, unawareness of HIV-seropositive status by pregnant women, poor health system, and the lack of funding for PMTCT services at private and rural health facilities were the major barriers preventing the use of PMTCT services. CONCLUSION: In order to reduce the missed opportunities for PMTCT interventions in Makurdi and by extension the Benue State it represents in Nigeria, strong political and financial commitments are needed to overcome the identified barriers.

HIV-free survival according to the early infant-feeding practices; a retrospective study in an anti-retroviral therapy programme in Makurdi, Nigeria.

BACKGROUND: In Nigeria, reports of the outcomes of prevention of mother to child transmission of HIV (PMTCT) interventions had been limited to the MTCT rates of HIV, with no information on HIV-free survival (HFS) in the HIV-exposed infants over time. METHODS: A retrospective study between June 2008 and December 2011 at the Federal Medical Centre, Makurdi, Nigeria comparing HFS rates at 3 and 18 months according to the infant feeding pattern at the 6th week of life. HFS was assessed by Kaplan-Meier analysis and association of maternal and infant variables and risk of HIV acquisition or death was tested in a Cox regression analysis. RESULTS: 801 HIV uninfected infants at 6 weeks of life were studied in accordance with their reported cumulative feeding pattern. This includes 196 infants on exclusive breast feeding (EBF); 544 on exclusive breast milk substitute (EBMS) feeding and 61 on mixed feeding (MF). The overall HFS was 94.4% at 3 months and this declined significantly to 87.1% at the 18 months of age (p-value=0.000). The infants on MF had the lowest HFS rates of 75.7% at 3 months and 69.8% at 18 months. The HFS rate for infants on EBF was 97.4% at 3 months and 92.5% at 18 month whilst infants on EBMS had HFS of 99.1% at 3 months and 86.2% at 18 months. A higher and significant drop off in HFS at the two time points occurred between infants on EBMS (12.9%) compared to infants on EBF (4.9%), p-value of 0.002, but not between infants on MF (5.9%) and EBMS, p-value of 0.114 and those on MF and EBF, p-value of 0.758. In Cox regression multivariate analyses; MF, gestational age of ˂37 weeks, and a high pre-delivery maternal viral load were consistently associated with HIV infection or death at 3 months and 18 months (p˂.05). CONCLUSION: For a better HFS in our setting; MF must be avoided, efforts to deliver babies at term in mothers with reduced viral load are advocated and EBF must be promoted as the safest and the most feasible mode of infant-feeding.