A Systematic Review of Yellow Fever Outbreaks and Public Health Responses in Nigeria.

Background: Yellow fever (YF) outbreaks continue to occur in Nigeria with a high mortality rate despite a well-established mode of transmission and the availability of a potent vaccine. This review is aimed at describing the epidemiology, determinants, and public health responses of yellow fever outbreaks in Nigeria from 1864 to 2020. Methodology: The guidelines for the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) were used to conduct the review from November 2020 to April 2021. PubMed database, WHO library databases, and Google Scholar were used to search for relevant published materials including original and reviewed articles, conference papers and case reports from 1864 to 2020. Results: Forty - eight articles and reports were included in the final reviews. Twenty - three outbreaks were described involving 33,830 suspected, presumptive, or confirmed cases of yellow fever and 8,355 deaths. The outbreaks occurred in every state of Nigeria including the Federal Capital Territory mostly during the rainy season. Low immunity in the population or low vaccination coverage, poor vector control, rainforest or savanna vegetation, rural-urban migration, and imported virus by travelers were common determinants noted. Public health responses have been through, centrally coordinated laboratory support, case management, emergency immunization, vector control, and surveillance. Conclusion: Yellow fever outbreaks have increased in frequency and geographical spread with associated mortality rates. To stem the tide, mass immunization with 17D vaccines is encouraged, planned urbanization with adequate vector control measures enforced, effective case definition, vector surveillance, and effective awareness campaigns should be emphasized.

Preparation for birth and complication readiness: rural-urban disparities among pregnant women in communities in Enugu State, Nigeria.

Introduction: birth preparedness and complication readiness (BPCR) is a key component of safe motherhood programs. The study aimed to determine the rural-urban disparities in BPCR and its predictors among pregnant women. Methods: this study was a community-based comparative cross-sectional study carried out among 366 pregnant women living in rural and urban areas in Enugu State, Nigeria. A multistage sampling technique was used to select the participants. Data analysis was carried out using descriptive statistics and inferential statistics at a significant level of p < 0.05. Results: among the respondents, 213 (58.2%) had good knowledge of the components of BPCR. However, a significantly higher proportion of those in urban areas had better knowledge of these components than those in rural areas (p=0.01). Generally, there was a poor practice of BPCR among both groups of respondents. However, between both groups of respondents, good practice of BPCR was statistically significantly higher in respondents from urban areas 69 (37.7%) than those in rural areas 47 (25.7%) (X2=6.108, p=0.013). Several factors were found to be associated with good practice of BPCR among the respondents however, the only predictor of good practice of BPCR among the urban respondents was being aware of free maternal and child health services in the State while for the rural respondents, it was having an assisted delivery in the last stages of pregnancy. Conclusion: there are rural-urban disparities in BPCR. Most pregnant women are knowledgeable about its components but the majority do not practice it appropriately.

Ergonomic assessment of work-related musculoskeletal disorder and its determinants among commercial mini bus drivers and driver assistants (mini bus conductors) in Nigeria.

INTRODUCTION: Work-related musculoskeletal disorder (WMSD) is a leading causes of occupational injury and disability among drivers and workers in the transport industry. This study evaluated the ergonomically assessed WMSD and its determinants among Nigerian commercial mini bus drivers (BD) and mini bus conductors (BC). METHOD: A total of 379 participants (BD = 200, BC = 179) were purposively sampled for this exploratory cross-sectional study. Participants' WMSD and work related variables were respectively assessed using the standardized Nordic questionnaire and a content-validated, Driving Work Station Assessment (DWSA) form. Data were analyzed descriptively and inferentially using chi-square and logistic regression. The level of significance was set at α = 0.05. RESULTS: The participants were aged between 20 and 66 years, with a mean age of 33.26±10.76years (BD = 38.42±10.22years, BC = 27.50±8.13years); most of whom consumed alcohol (84.4%) and experienced severe job stress (73.4%). There was a high prevalence (95.8%; BD = 94.5%, BC = 97.8%) of WMSDs, the lower back (66.8%) and upper back (54.1%) had the highest regional prevalence of WMSD. The BC (BC vs BD) had significantly (p<0.05) higher prevalence of Neck (47.7% vs 21.5%) and upper back (80.4% vs 30.5%) WMSDs. Conversely, the BD (BD vs BC) had significantly (p<0.05) higher prevalence of low-back (85.0% vs 46.4%), knee (25.0% vs 9.5%), elbow (11.5% vs 3.9%), and wrist (10.5% vs 3.4%) WMSD. There was a significant association between WMSD and each of work duration (X2 = 11.634, p = 0.009), work frequency (X2 = 8.394, p = 0.039), job dissatisfaction (X2 = 10.620, p = 0.001) and job stress (X2 = 16.879, p = 0.001). Working beyond 4days/week (OR = 10.019, p = 0.001), job dissatisfaction (OR = 1.990, p = 0.031), constrained working postures (OR = 5.324, p = 0.003) and fatigue (OR = 4.719, p = 0.002) were the predictors of WMSD. CONCLUSION: Job stress, work duration and work frequency, posture and fatigue are important determinants of WMSDs among mini bus drivers and their assistants in Nigeria. Ergonomics training intervention for this population is recommended.

Awareness, acceptability and uptake of cervical cancer vaccination services among female secondary school teachers in Enugu, Nigeria: a cross-sectional study.

INTRODUCTION: cervical cancer is a major cause of morbidity and mortality in women and vaccination of adolescents with human papilloma virus (HPV) vaccines is a major preventive strategy for this cancer. Despite the usefulness of cervical cancer vaccines, significant gaps still exist in the level of awareness and acceptability of the vaccine among women. This study aimed to determine the level of awareness, acceptability, and identify the factors associated with the uptake of this vaccine by female secondary school teachers in Enugu, Nigeria. METHODS: a cross-sectional study of 377 female teachers in Enugu metropolis was undertaken between July and October 2017. A structured interviewer-administered pretested questionnaire was used for data collection and SPSS used for analysis. RESULTS: less than half (41.9%) of the respondents had good knowledge of the cervical cancer vaccine. The majority of the respondents (93.6%) accepted the vaccine and will recommend it for their children and students. Only 14.6% and 9.0% of the respondents have taught their students about cervical cancer or HPV vaccines and had a programme in their school that addresses cervical cancer or cervical cancer vaccination respectively. Only 3.4% of the respondents have been vaccinated while 5.6% of their children or relatives have received the HPV vaccine. Previous vaccination of participants (p = 0.000), existing programmes addressing cervical cancer in schools of respondents (p = 0.000), participants having taught students about cervical cancer (p = 0.025) and high economic status (p = 0.013) significantly increased the likelihood of participants vaccinating their adolescent daughters/relatives. Extremes of age (p = 0.001) and being the head of their families (p = 0.002) significantly reduced the likelihood of the daughters/relatives to be vaccinated. Only previous history of vaccination of the respondents predicted the vaccination of their children and relatives (AOR = 6.069; 95% CI; < 0.0001-0.041). CONCLUSION: the overall knowledge of the HPV vaccine was low but the acceptability was high among respondents who were aware of the vaccines. Vaccine uptake among children/family members of the respondents was low. The introduction of cervical cancer vaccination education of the teachers in the secondary schools will help improve cervical cancer vaccination and the uptake among adolescent´s populations in the country.

Human immunodeficiency virus status disclosure among people living with human immunodeficiency virus receiving care in Enugu, Nigeria: A mixed method study.

BACKGROUND: Disclosure of human immunodeficiency virus (HIV) status has potential benefits for both the individual and society. OBJECTIVES: This study aimed to determine the disclosure rate and its associated factors in people living with HIV receiving care in Enugu, Nigeria. METHODS: A cross-sectional study using mixed methods was carried out in 5 comprehensive treatment facilities in Enugu, Nigeria during March to August 2019. 300 participants for the quantitative aspect were selected using a simple random sampling method and 30 participants for the qualitative aspect were selected purposively. Interviewer administered questionnaire and focus group discussion were applied for data collection. The quantitative data was analyzed using Epi info version 7; Chi-square test and multivariable logistic regression were applied and a level of statistical significance was set at P < 0.05. The qualitative data were analyzed using thematic analysis. RESULTS: Among 300 participants, 241 (80.3%) had voluntarily disclosed their status to someone within their social network. 228 respondents had sexual partners and 122 (52.4%) had disclosed to their sexual partners. Twenty-five (11.0%) disclosed to their partners on the day of diagnosis. Predictors of disclosure were being female, having a formal education and being 35 years or more. CONCLUSION: This study revealed high voluntary disclosure rate to someone within the social network, but lower and delayed disclosure rate to sexual partners.

Comparison of knowledge of occupational hazards of lead exposure and blood lead estimation among roadside and organized panel beaters in Enugu metropolis, Nigeria.

INTRODUCTION: occupational practices continuously exposes workers to hazards of lead. This study aimed to compare the knowledge of occupational hazards associated with lead exposure, and blood lead estimation among roadside and organized panel beaters in Enugu metropolis, Nigeria. METHODS: this was a cross-sectional study. Multistage sampling method was used to select 428 panel beaters in Enugu metropolis. Samples were analyzed using Atomic Absorption Spectrometer at 283.3 wavelengths. Data were entered and analyzed using Statistical Package for Social Science 20. Comparative analysis were done using chi - square, T-test, Mann-Whitney U-test, Kruskal-Wallis test, logistic regression and level of significance was set at 5%. RESULTS: the majority of respondents on both roadside (59.8%) and organized (73.4%) sectors had poor knowledge of hazards of lead exposure. The difference was significant using χ2 (P<0.05). The median blood lead levels were 3.0µg|dl and 16.0µg|dl for roadside and organized panel beaters respectively. The difference was significant with Mann-Whitney U test (P<0.001). The prevalence of elevated blood lead at 10µg|dl were 36.9% (roadside sector) and 64.5% (organized sector). The duration of working hours (OR = 4.34, CI = 1.729 - 10.338) was found to be the predictor of elevated blood lead levels. CONCLUSION: there were general poor knowledge of hazards of lead exposure and high prevalence of elevated lead levels which were more among organized panel beaters. Advocacy on standard organizational structures that support improved occupational health practices is needed and routine outreach by research institutions for health education and safety training.

Public's knowledge of the differences between ophthalmologists and optometrists: a critical issue in eye care service utilisation.

AIM: To assess the public's knowledge of the differences between ophthalmologists and optometrists and identify the factors associated with knowledge. METHODS: The study was a population-based random survey of adults aged 18 years or older conducted in Enugu, south eastern Nigeria, between March and June, 2011. Data on respondents' socio-demographics, clinical profile, and knowledge of the differences between ophthalmologists and optometrists were collected using a 28-item questionnaire. Data were analysed using descriptive and analytical statistics. Values of P<0.05 were considered statistically significant. RESULTS: The respondents (n=394) comprised 198 males and 196 females (sex ratio=1.01:1), aged 18-70 (30.9±10.8) years. The majority of respondents were single (57.4%), possessed secondary education (96.9%), employed (65.2%) and had no health insurance (77.4%). Their clinical profile showed previous eye exam 54.1%, spectacle wear 41.6% and contact lens wear 5.6%. In the multivariate analysis, participants' good knowledge of the differences between ophthalmologists and optometrists was significantly associated with educational status (OR: 0.32, 95% CI: 0.23-0.44, P<0.0001, ß=-0.988), employment status (OR: 1.8, 95% CI: 1.45-2.25, P<0.0001, ß=0.124) and previous eye examination (OR: 1.63, 95% CI: 1.29-2.07, P<0.0001, ß=0.549). CONCLUSION: Participants' socio-demographic and clinical characteristics are important predictors of good knowledge. The findings may have implications for all stakeholders in eye care delivery. There is need for knowledge enhancement, by the government and eye care providers, through population-based eye health literacy campaigns.

Trainee resident participation in health research in a resource-constrained setting in south-eastern Nigeria: perspectives, issues and challenges. A cross-sectional survey of three residency training centres.

BACKGROUND: The participation of trainers and trainees in health research is critical to advance medical science. Overcoming barriers and enhancing incentives are essential to sustain a research culture and extend the frontiers of medical education. In this study, we investigated the roles of individual and system factors influencing trainee resident participation in health research in Enugu, south-eastern Nigeria. METHODS: This cross-sectional survey of trainee residents was conducted across three residency training centres in Enugu, Nigeria, between February and March, 2010. The number and speciality distribution of trainee residents were determined from personnel records at each centre. A 19-item questionnaire was used to record demographic characteristics, research training/experience, and attitudes toward and perceived barriers to health research. Data were analysed to yield frequencies, percentages and proportions. Values of p<0.05 were considered significant. RESULTS: The response rate was 93.2%. The respondents (n=136) comprised 109 males and 27 females. Their mean±standard deviation age was 35.8±5.6 years (range: 25-53 years). Participation in research was significantly associated with previous research training [odds ratio (OR): 2.90; 95% confidence interval (CI): 1.35-6.25, p=0.003, ß=22.57], previous research participation (OR: 2.21; 95% CI: 0.94-5.29, p=0.047, ß=22.53) and research publication (OR: 2.63; 95% CI: 1.00-7.06, p=0.03, ß=22.57). Attitude towards research was significantly influenced by perceived usefulness of research in patient care (OR: 7.10; 95% CI: 3.33-15.13, p=0.001), job promotion (OR: 8.97; 95% CI: 4.12-19.53, p=0.001) and better understanding of disease (OR: 21.37; 95% CI: 8.71-54.44, p=0.001). Time constraints (OR: 0.06; 95% CI=0.025-0.14, p=0.001), funding (OR: 0.028; 95% CI: 0.008-0.10, p=0.001) and mentorship (OR: 0.086; 95% CI: 0.36-0.21, p=0.001) were significant barriers to research participation. CONCLUSIONS: System and individual factors are significant incentives to research participation, while system-derived factors are significant barriers. Pre-residency research, dedicated research time, adequate research funding and commensurate research mentorship rewards are instructive. Prospective longitudinal studies are warranted to confirm these findings.

Factors influencing choice of medical specialty of preresidency medical graduates in southeastern Nigeria.

BACKGROUND: This study examined the determinants of specialty choice of preresidency medical graduates in southeastern Nigeria. METHODS: We used a comparative cross-sectional survey of preresidency medical graduates who took the Basic Sciences Examination of the Postgraduate Medical College in Enugu, southeastern Nigeria, in March 2007. Data on participants' demographics and specialty selected, the timing of the decision, and factors in specialty selection were collected using a questionnaire. Data were examined using descriptive and analytical statistics. P < .05 was considered significant. RESULTS: The survey response rate was 90.8% (287 of 316). The sample included 219 men and 68 women, ranging in age from 24 to 53 years and with a mean age of 33.5 ± 1.1 (SD) years. Career choice was more frequently influenced by personal interest (66.6%), career prospects (9.1%), and appraisal of own skills/aptitudes (5.6%), and it was least affected by altruistic motives (1.7%) and influence of parents/relations (1.7%). The respondents selected specialties at different rates: obstetrics and gynecology (22.6%), surgery (19.6%), pediatrics (16.0%), anesthesiology (3.1%), psychiatry (0.3%), and dentistry (0.0%). Most (97.2%) participants had decided on specialty choice by the end of their fifth (of a total 16 years) postgraduate year. The participants significantly more frequently preferred surgery and pediatrics to other disciplines (P < .002, after Bonferroni correction for multiple comparisons). CONCLUSIONS: Preresidency medical graduates in southeastern Nigeria were influenced by personal interest, career prospects, and personal skills/aptitude in deciding which specialty training to pursue. The most frequently chosen specialties were surgery and pediatrics. These findings have implications for Nigeria's education and health care policy makers.