The impact of introduction of the 10-valent pneumococcal conjugate vaccine on pneumococcal carriage in Nigeria.

Pneumococcal conjugate vaccines (PCVs) protect against invasive pneumococcal disease (IPD) among vaccinees. However, at population level, this protection is driven by indirect effects. PCVs prevent nasopharyngeal acquisition of vaccine-serotype (VT) pneumococci, reducing onward transmission. Each disease episode is preceded by infection from a carrier, so vaccine impacts on carriage provide a minimum estimate of disease reduction in settings lacking expensive IPD surveillance. We documented carriage prevalence and vaccine coverage in two settings in Nigeria annually (2016-2020) following PCV10 introduction in 2016. Among 4,684 rural participants, VT carriage prevalence fell from 21 to 12% as childhood (<5 years) vaccine coverage rose from 7 to 84%. Among 2,135 urban participants, VT carriage prevalence fell from 16 to 9% as uptake rose from 15 to 94%. Within these ranges, carriage prevalence declined with uptake. Increasing PCV10 coverage reduced pneumococcal infection at all ages, implying at least a comparable reduction in IPD.

Hunger in the midst of plenty: A survey of household food security among urban families in Lagos State, Nigeria.

Research has documented that food security at national level does not translate to food security at household level. The study assessed the level of food security among urban households in Shomolu LGA, Lagos State. Using the 9-item Household Food Insecurity Access Scale (HFIAS) information was collected from 306 heads of households on adequacy of food availability and consumption. Data were analyzed using Epi info and presented as frequencies and percentages. Associations between variables were tested using Chisquare at a significance level of 0.05. Households were classified as food secure, food insecure without hunger and food insecure with hunger. Only 33.8% of households were food secure, 45.1% were food insecure without hunger and 21.1% were food insecure with hunger. Food secure households were statistically significantly associated with households where heads had secondary or higher education, women were married, spending <40% of household monthly income on food and living in their own homes (P=0.001). Household food insecurity is found in urban communities and is positively associated with indicators of poverty.

Hunger in the midst of plenty: a survey of household food security among urban families in Lagos State, Nigeria

Research has documented that food security at national level does not translate to food security at household level. The study assessed the level of food security among urban households in Shomolu LGA, Lagos State. Using the 9-item Household Food Insecurity Access Scale (HFIAS) information was collected from 306 heads of households on adequacy of food availability and consumption. Data were analyzed using Epi info and presented as frequencies and percentages. Associations between variables were tested using Chisquare at a significance level of 0.05. Households were classified as food secure, food insecure without hunger and food insecure with hunger. Only 33.8% of households were food secure, 45.1% were food insecure without hunger and 21.1% were food insecure with hunger. Food secure households were statistically significantly associated with households where heads had secondary or higher education, women were married, spending <40% of household monthly income on food and living in their own homes (P=0.001). Household food insecurity is found in urban communities and is positively associated with indicators of poverty

Nasopharyngeal Pneumococcal Carriage in Nigeria: a two-site, population-based survey.

Changes in nasopharyngeal (NP) carriage of vaccine-type (VT) Streptococcus pneumoniae can be used to assess the effectiveness of a pneumococcal conjugate vaccine (PCV10). We conducted a baseline carriage survey in rural (Kumbotso, Kano) and urban (Pakoto, Ogun) Nigeria. In this cross-sectional study, we obtained data on demography, clinical history, risk factors, and took NP swabs for pneumococcal culture. We calculated crude and age-standardised carriage prevalence and used log-binomial regression to assess risk factors for carriage. Among children aged <5 years, 92% (95% CI: 88-95%) and 78% (73-82%), respectively, carried any pneumococcus and 48% and 50%, respectively, carried PCV10 serotypes. In Kumbotso, carriage prevalence was >40% across all ages. The age-standardized prevalence of pneumococcal carriage was 66% in Kumbotso and 40% in Pakoto. The most commonly identified serotypes were 19 F, 6 A and 23 F. Risk factors for carriage were young age, recent rhinorrhoea, cohabitation with ≥2 children aged <5 years, and sharing a bed with ≥2 persons. Pneumococcal carriage prevalence is high in this Nigerian population. Persisting prevalence of VT-carriage in older children and adults suggests that PCV10 introduction in children will not eliminate transmission of vaccine serotypes rapidly. High vaccine coverage will therefore be required to ensure full protection of children.

Comparing the knowledge, attitude and practices of health care workers in public and private primary care facilities in Lagos State on Ebola virus disease.

INTRODUCTION: The West African sub-region is currently witnessing an outbreak of EVD that began in December 2013. The first case in Nigeria was diagnosed in Lagos, at a private medical facility in July 2014. Health care workers are known amplifiers of the disease. The study aimed to determine and compare EVD knowledge, attitude and practices among HCWs in public and private primary care facilities in Lagos, Nigeria. METHODS: This was a comparative cross-sectional study. Seventeen public and private primary care facilities were selected from the 3 senatorial districts that make up Lagos State. 388 respondents from these facilities were selected at random and interviewed using a structured questionnaire. RESULTS: Proportion of respondents with good knowledge and practice among public HCWs was 98.5% and 93.8%; and among private HCW, 95.9% and 89.7%. Proportion of respondents with positive attitude was 67% (public) and 72.7% (private). Overall, there were no statistically significant differences between the knowledge, attitude and preventive practices of public HCWs and that of private HCWs, (p≤0.05). CONCLUSION: Timely and intense social mobilization and awareness campaigns are the best tools to educate all segments of the community about public health emergencies. There exists significant surmountable gaps in EVD knowledge, negative attitude and sub-standard preventive practices that can be eliminated through continued training of HCW and provision of adequate material resources.

Pre-vaccination nasopharyngeal pneumococcal carriage in a Nigerian population: epidemiology and population biology.

BACKGROUND: Introduction of pneumococcal vaccines in Nigeria is a priority as part of the Accelerated Vaccine Introduction Initiative (AVI) of the Global Alliance for Vaccines and Immunisation (GAVI). However, country data on the burden of pneumococcal disease (IPD) is limited and coverage by available conjugate vaccines is unknown. This study was carried out to describe the pre vaccination epidemiology and population biology of pneumococcal carriage in Nigeria. METHODS: This was a cross sectional survey. Nasopharyngeal swabs (NPS) were obtained from a population sample in 14 contiguous peri-urban Nigerian communities. Data on demographic characteristics and risk factor for carriage were obtained from all study participants. Pneumococci isolated from NPS were characterised by serotyping, antimicrobial susceptibility and Multi Locus Sequencing Typing (MLST). RESULTS: The prevalence of pneumococcal carriage was 52.5%. Carriage was higher in children compared to adults (67.4% vs. 26%), highest (≈90%) in infants aged <9 months and reduced significantly with increasing age (P<0.001). Serotypes 19F (18.6%) and 6A (14.4%) were most predominant. Potential vaccine coverage was 43.8%, 45.0% and 62% for PCV-7, PCV-10 and PCV-13 respectively. There were 16 novel alleles, 72 different sequence types (STs) from the isolates and 3 Sequence Types (280, 310 and 5543) were associated with isolates of more than one serotype indicative of serotype switching. Antimicrobial resistance was high for cotrimoxazole (93%) and tetracycline (84%), a third of isolates had intermediate resistance to penicillin. Young age was the only risk factor significantly associated with carriage. CONCLUSIONS: Pneumococcal carriage and serotype diversity is highly prevalent in Nigeria especially in infants. Based on the coverage of serotypes in this study, PCV-13 is the obvious choice to reduce disease burden and prevalence of drug resistant pneumococci. However, its use will require careful monitoring. Our findings provide sound baseline data for impact assessment following vaccine introduction in Nigeria.

Infants delivered in maternity homes run by traditional birth attendants in urban Nigeria: a community-based study.

We explored factors associated with traditional maternity/herbal homes (TMHs) run by traditional birth attendants (TBAs) compared with hospital or home delivery in Lagos, Nigeria, and found that infants delivered at TMHs were less likely to have severe hyperbilirubinemia compared with infants delivered in hospitals or residential homes. These infants were also less likely to be preterm compared with those delivered in hospitals or undernourished compared with infants delivered in residential homes. We concluded that infants delivered at TMHs who survive are unlikely to be at greater risks of some adverse perinatal outcomes than those delivered in hospitals or family homes.

Preference for private hospital-based maternity services in inner-city Lagos, Nigeria: An observational study.

OBJECTIVES: To determine factors associated with maternal preference for delivery in private hospitals in an urban community in sub-Saharan Africa. METHODS: A cross-sectional study of socio-demographic and obstetric characteristics of mothers and their newborns attending Bacille Calmette-Guérin (BCG) immunization clinics in inner-city Lagos, Nigeria. Factors associated with delivery in private hospitals were determined using multivariable logistic regression analyses. RESULTS: Of the 3296 mothers enlisted for this study 1659 (50.3%) delivered in private hospitals and 1637 (49.7%) in public hospitals. Government hospitals had a higher proportion of doctors at delivery. Use of private obstetric services was significantly associated with ethnicity, religion, social class and obstetric history. Infants delivered at private hospitals were significantly more likely to be undernourished and have severe hyperbilirubinemia but less likely to be preterm and at no greater risk of hearing loss. CONCLUSIONS: Current global strategies to expand facility-based deliveries in order to reduce maternal and child mortality rates need to be complemented by improved regulatory/supervisory framework at country levels to better serve mothers and their offspring in urban areas who may opt for private hospitals usually lacking adequate obstetric and pediatric facilities against the backdrop of the rapid urban transition in Africa.

Health care providers' knowledge of, attitudes toward and provision of emergency contraceptives in Lagos, Nigeria.

CONTEXT: Emergency contraception can play an important role in reducing the rate of unintended pregnancies in Nigeria. Although it is included in the national family planning guidelines, there is limited awareness of this method among clients. METHODS: In 2003-2004, a sample of 256 health care providers within Lagos State were surveyed about their knowledge of, attitudes toward and provision of emergency contraceptives, using a 25-item, self-administered questionnaire. Frequencies were calculated for the various measures, and chi-square tests were used to determine significant differences. RESULTS: Nine in 10 providers had heard of emergency contraception, but many lacked specific knowledge about the method. Only half of them knew the correct time frame for effective use of emergency contraceptive pills, and three-fourths knew that the pills prevent pregnancy; more than a third incorrectly believed that they may act as an abortifacient. Fewer than a third of respondents who had heard of the pills knew that they are legal in Nigeria. Of those who had heard about emergency contraception, 58% had provided clients with emergency contraceptive pills, yet only 10% of these providers could correctly identify the drug, dose and timing of the first pill in the regimen. Furthermore, fewer than one in 10 of those who knew of emergency contraception said they always provided information to clients, whereas a fourth said they never did so. CONCLUSIONS: Nigerian health care providers urgently need education about emergency contraception; training programs should target the types of providers who are less knowledgeable about the method.