Global prevalence and correlates of mpox vaccine acceptance and uptake: a systematic review and meta-analysis.

BACKGROUND: Vaccination has been recommended as one of the most potent ways of controlling the mpox (formerly, monkeypox) outbreak, particularly among high-risk groups. Here, we evaluated the prevalence of mpox vaccine acceptance and uptake globally. METHODS: We searched multiple databases for peer-reviewed studies published in English from May 2022 to 25th November 2023 that evaluated mpox vaccine acceptance and/or uptake. We fit a random-effects model meta-analysis to calculate the pooled mpox vaccine acceptance and uptake rates, with their 95% confidence intervals (CI) across population outcomes. We performed subgroup analyses among the six World Health Organization (WHO) regions (Africa [AFR], Region of the Americas [AMR], South-East Asia Region [SEAR], European Region [EUR], Eastern Mediterranean Region [EMR], and the Western Pacific Region [WPR]), as well as among select population subgroups. RESULTS: Of the 2531 studies screened, 61 studies, with a cumulative sample size of 263,857 participants from 87 countries were eligible for inclusion. The overall vaccine acceptance and uptake rates were 59.7% and 30.9% globally. Acceptance and uptake rates among the LGBTQI+ community were 73.6% vs 39.8% globally, 60.9% vs. 37.1% in AMR, 80.9% vs. 50.0% in EUR, and 75.2% vs. 33.5% in WPR. Among PLHIV, vaccine acceptance and uptake rates were 66.4% vs. 35.7% globally, 64.0% vs. 33.9% in AMR, 65.1% vs. 27.0% in EUR, and 69.5% vs. 46.6% in WPR. Among healthcare workers, vaccination intention was 51.0% globally. CONCLUSIONS: Tailored interventions are needed to bolster confidence in the mpox vaccine, maximize vaccine uptake, and increase vaccine access to close the gaps between acceptance and uptake especially among key populations residing in regions with low rates of acceptance and uptake.

Mpox is an infection caused by the monkeypox virus and is transmitted through direct contact with infected animals or people, or indirectly through contact with contaminated materials. An unprecedented mpox outbreak spanning all continents occurred in 2022. Vaccination against the infection by high-risk groups, including the LGBTQI+ community and frontline healthcare workers has been recommended by the WHO as essential to outbreak control. To investigate the rates and factors associated with mpox vaccine acceptance and uptake across population subgroups (LGBTQI+ community, healthcare workers, people living with HIV, and the general public), we undertook this global systematic review and meta-analysis of the available evidence. Our results reveal substantial global and regional variations in the rates of mpox vaccine acceptance and uptake across population groups, with wide acceptance-uptake gaps, indicating the need for behavioral interventions to increase mpox vaccine confidence and uptake.

Depression mediates the relationship between exposure to stigma and medication adherence among people living with HIV in low-resource setting: a structural equation modeling approach.

This study hypothesizes that depression mediates the association between exposure to stigma and medication non-adherence in people living with HIV (PLHIV). We recruited 372 PLHIV from the Stigma, health-related Quality of life, antiretroviral Adherence, and Depression among people living with HIV (SQuAD-HIV) project, a multicenter cross-sectional study conducted between October 2021 and February 2022 among PLHIV attending six ART clinics in two geopolitical regions of northern Nigeria. A structural equation modeling (SEM) framework, utilizing the full information maximum likelihood estimator, was used to elucidate the pathways linking stigma, depression, and ART medication adherence, adjusting for sociodemographic characteristics. The total number of eligible participants analyzed (353) included 32.7% male PLHIV with a mean age (SD) of 39.42 (10.14). Being female was positively associated with adherence (ß, 95% CI 0.335, 0.163-0.523, p-value < 0.001) but negatively associated with stigma (ß, 95% CI - 0.334, - 0.561 to - 0.142, p-value = 0.001), while urban residence was negatively associated with stigma (ß, 95% CI - 0.564, - 0.804 to - 0.340, p-value < 0.001). Our analysis also indicated that a higher level of experienced stigma was associated with decreased medication adherence. This association was partially mediated by depression (indirect effect = (0.256) (- 0.541) = - 0.139; p-value < 0.01). The proportion of the association between stigma and medication adherence explained through mediation by depression was 35.6%. These findings underscore the need for targeted interventions aimed at lowering exposure to stigma among PLHIV to improve medication adherence.

A Qualitative Study of HIV Testing Experiences and HIV Self-Testing Perspectives among Men in Northern Nigeria.

HIV self-testing (HIVST) holds promise for accessing hard-to-reach populations by overcoming sociocultural and structural barriers to awareness of HIV status. This phenomenological qualitative study explored the experiences and perspectives of married men in Kano, northern Nigeria, regarding HIV testing and counseling (HTC) and HIVST. Twenty married men from diverse socioeconomic backgrounds participated in in-depth interviews conducted in the local language. Thematic analysis was employed to analyze the data, yielding key themes related to prior test experiences, knowledge of self-testing, and perceived ease of use, in addition to motivation for self-testing and concerns about reliability and counseling support. The findings shed light on the impact of facility-based HIV testing experiences on the perspectives of participants. Concerns related to delays, overcrowding, discomfort, fear, and unsupportive attitudes from healthcare providers influenced their perceptions. Among persons with previous self-testing experience, initial uneasiness was overcome with repeated use, highlighting the ease of use associated with HIVST. Motivations for self-testing included privacy, convenience, personal empowerment, improved infection detection, and efficiency. Concerns were raised regarding the reliability of self-testing results compared to hospital-based testing, and the absence of counseling support during self-testing. Our findings underscore the need to address infrastructural limitations, enhance counseling support, and promote awareness and knowledge of HIVST.

The V-BRCH Project: Strengthening HIV Research Capacity in Nigeria through Intensive Workshops in Implementation Science and Grant Writing.

As persons with HIV live longer as the result of antiretroviral therapy, morbidity from HIV-associated noncommunicable diseases (NCDs) is increasing. The Vanderbilt-Nigeria Building Research Capacity in HIV and Noncommunicable Diseases program is a training platform created with the goal of training a cohort of successful Nigerian investigators to become leaders in HIV-associated NCD research. We describe survey findings from two week-long workshops in Kano, Nigeria, where trainees received instruction in implementation science and grant writing. Surveys assessed participants' self-perceived knowledge and confidence in topics taught during these workshops. Thirty-seven participants (all assistant professors) attended the implementation science workshop; 30 attended the grant-writing workshop. Response rates for the implementation science workshop were 89.2% for the preworkshop survey and 91.9% for the postworkshop survey. For the grant-writing workshop, these values were 88.2% and 85.3%, respectively. Improvement in participant knowledge and confidence was observed in every domain measured for both workshops. On average, a 101.4% increase in knowledge and a 118.0% increase in confidence was observed across measured domains among participants in the implementation science workshop. For the grant-writing workshop, there was a 68.8% increase in knowledge and a 70.3% increase in confidence observed. Participants rated the workshops and instructors as effective for both workshops. These workshops improved participants' knowledge and competence in implementation science and grant writing, and provide a model for training programs that aim to provide physician scientists with the skills needed to compete for independent funding, conduct locally relevant research, and disseminate research findings.

Telemedicine Service Adoption During the COVID-19 Pandemic: Physicians' Experience from Nigeria.

Introduction: Telemedicine practice experiences during the COVID-19 pandemic have not been well documented in resource-constrained settings, such as Nigeria. We set out to assess knowledge, attitude, and factors associated with telemedicine practice during the COVID-19 lockdown, as well as physician experiences in Kano, Nigeria. Methods: We employed a mixed-methods approach, utilizing structured questionnaires administered to 246 physicians, followed by in-depth interviews with a purposive subsample of 20 individuals. The data were analyzed using logistic regression and the framework approach. Results: Overall, 65.0% of the respondents demonstrated moderate to good knowledge of telemedicine. Before COVID, only 47.6% (n = 117) reported practicing telemedicine, compared with 77.2% (n = 190) during the COVID lockdown (p < 0.05). Factors associated with telemedicine practice included having at least 5 years of work experience, working in pediatrics, undergoing senior residency training, receiving formal telemedicine training, possessing good knowledge of telemedicine, and having a positive attitude toward it. The odds of engaging in telemedicine practice were four times higher (adjusted odds ratio = 4.10, 95% confidence interval: 1.79-9.40) for those who practiced it before the pandemic. Challenges identified included knowledge and skill gaps, slow internet connectivity, unstable electricity, and inadequate equipment. Conclusion: To enhance telemedicine practice in resource-limited settings, it is important to focus on strengthening information and communication infrastructure, providing comprehensive clinician training, implementing careful patient selection processes, and improving practice guidelines.

A systematic review and meta-analysis of the global prevalence and determinants of COVID-19 vaccine acceptance and uptake in people living with HIV.

People living with HIV (PLHIV) are at higher risk of poor outcomes of SARS-CoV-2 infection. Here we report the pooled prevalence of COVID-19 vaccine acceptance/uptake and determinants among this vulnerable population of PLHIV based on a systematic review and meta-analysis of studies published by 25 August 2023. Among the 54 included studies (N = 167,485 participants), 53 (N = 166,455) provided data on vaccine acceptance rate, while 27 (N = 150,926) provided uptake data. The global prevalences of COVID-19 vaccine acceptance and uptake were 67.0% and 56.6%, respectively. Acceptance and uptake rates were 86.6% and 90.1% for the European Region, 74.9% and 71.6% for the Region of the Americas, 62.3% and 78.9% for the South-East Asian Region, 64.6% and 19.3% for the Eastern Mediterranean Region, 58.0% and 35.5% for the African Region, and 57.4% and 44.0% for the Western Pacific Region. The acceptance rate increased from 65.9% in 2020 to 71.0% in 2022, and the uptake rate increased from 55.9% in 2021 to 58.1% in 2022. Men, PLHIV aged ≥40 years and those who had recently received the influenza vaccine were more likely to accept and receive the COVID-19 vaccine. Factors associated with lower uptake included Black race, other races (Latinx/Hispanic/mixed race), low education level and being unemployed. Vaccine-related factors associated with higher acceptance included belief in vaccine effectiveness, vaccine trust, perceived high susceptibility to SARS-CoV-2 infection and fear of potential COVID-19 effect in PLHIV. Sustained efforts and targeted interventions are needed to reduce regional disparities in COVID-19 vaccine uptake among PLHIV.

Factors associated with hypertension among adults in high burden kidney disease areas of Jigawa State, Nigeria: A cross-sectional survey.

Background: Hypertension is the leading risk factor for preventable cardiovascular-related complications and mortalities worldwide. Materials and Methods: A cross-sectional survey was conducted to assess the prevalence and factors associated with hypertension among 361 adults from four local government areas (LGAs) of Jigawa state identified to have high burden of kidney diseases. The Modified WHO STEPS questionnaire and multi-stage sampling technique were employed and data were analysed using IBM SPSS version 22.0. Results: The age of the respondents ranged from 18 to 102 years with a median of 45 (interquartile range = 30-80) years. More than a quarter (34.9%) of the respondents were unemployed. Few reported history of alcohol ingestion (0.8%) and cigarette smoking (1.1%). The prevalence of systolic hypertension was 116 (32.1%), while that of diastolic hypertension was 133 (36.8%). Jahun LGA had higher cases (36.7%) of systolic hypertension, whereas Dutse LGA had higher cases (47.8%) of diastolic hypertension. Systolic hypertension was significantly higher (P < 0.001) among those >35 years of age. The odds of developing systolic hypertension were significantly lower among those between the ages of 18 and 35 years, and those between the ages of 18 and 35 years were less likely to have systolic hypertension than those above the age of 35 years (adjusted odds ratio = 9.0; 95% confidence interval = 4.6-17.6). Similarly, those who reported family history of diabetes and hypertension (P < 0.001) had a significantly higher proportion of systolic hypertension. Conclusions: The prevalence of hypertension was alarming in the high burden kidney disease areas. The government should develop a sustainable model for the mass community screening of risk factors and community-based health insurance for the effective management of all identified cases.

Burden, socio-demographic and other risk factors associated with haemodialysis in North-west Nigeria: A retrospective multicentre analysis.

Background: Kidney diseases requiring haemodialysis are becoming an emerging public health problem. This study aimed to determine the burden, socio-demographic and other risk factors associated with haemodialysis in Northwest Nigeria. Methodology: The study was a retrospective multicentre review of secondary data from the dialysis centres of public hospitals in northwestern Nigeria. Risk factors for renal failure were examined in 1329 patients who were enrolled for haemodialysis between 2019 and 2022 in the four public dialysis centres in Kano and Jigawa state. Data were analysed using IBM SPSS Statistics for Windows, version 22.0, with statistical significance set at P ≤ 0.05. Results: The minimum age of the patients was 2 years and the maximum was 100 years with a median of 48 (interquartile range = 31, 60) years. Chronic kidney disease (CKD) was found amongst more than two-thirds 998 (75.1%) of the patients. Up to 51 (3.8%), 62 (4.7%) and 10 (0.8%) were seropositive for HIV, hepatitis B and hepatitis C, respectively. Acute kidney injury (AKI) was significantly higher (67.9%, P < 0.001) amongst patients with post-partum haemorrhage (PPH), and were 24 times more likely to develop AKI when compared with those with no PPH (adjusted odds ratio [aOR] =24, 95% confidence interval [CI] = [13.5-44.5]). CKD was significantly higher amongst patients with hypertension (HTN) (84.9%, P < 0.001), and were 3.2 times more likely to develop CKD compared with non-hypertensives (aOR = 3.2, 95% CI = [2.4-4.1]). Acute on CKD (AOCCKD) was significantly higher amongst patients with chronic glomerulonephritis (CGN) (28.1%, P < 0.001), and were three times more likely to develop AOCCKD than those without CGN (aOR = 3, 95% CI = [2.1-4.2]). Conclusion: PPH was the major reason for AKI related haemodialysis while diabetes and HTN were the major causes of CKD-requiring haemodialysis. CGN was more amongst patients who had dialysis due to acute exacerbation of CKD. The government and relevant stakeholders should ensure a favourable policy for the screening and management of patients.

Adherence to recommended hospital waste management practices by healthcare workers at Murtala Muhammad Specialist Hospital Kano, Nigeria.

Introduction: the aim of this study was to determine what proportion of patients with confirmed esophageal cancer at the largest hospital in the country were recorded in the Zambia National Cancer Registry (ZNCR). Methods: we reviewed esophageal cancer records at the University Teaching Hospital (UTH) and ZNCR, between 2015 and 2017. Using Stata version 15, data were summarised and the Kruskal-Wallis was used to compute comparisons, Kaplan-Meier curves for survival estimates and Cox regression for associated factors. Results: included in the final analysis were records for 222 patients with confirmed esophageal cancer and of these 51/222 (41%) were appearing in the ZNCR. The mean age of the patients was 56.2 years (SD, 13.0) and only 2/222 (1%) were confirmed alive at the time of data analysis. The median time from endoscopic diagnosis to histological confirmation was 12.5 days (IQR 7.5 - 21.5) and arrival at the Cancer Diseases Hospital (CDH) for treatment was 20 days (IQR 10 - 34). The overall median survival time in the study was 259 days (CI 95%; 151 - 501). Age, sex, time to diagnosis, histological classification and grade of tumour did not show any evidence of predicting survival in both the univariate and multivariable cox regression model (p>0.05). Conclusion: a significant proportion of esophageal cancer cases seen at UTH were not included in the national registry suggesting that official figures for the prevalence of esophageal cancer in Zambia are underestimated. There is an urgent need to improve the collection of data on esophageal cancer in Zambia.

'We delivered at home out of fear': Maternity Care in Rural Nigeria During the COVID-19 Pandemic.

Background and Objective: The COVID-19 pandemic response overwhelmed health systems, disrupting other services, including maternal health services. The disruptive effects on the utilization of maternal health services in low-resource settings, including Nigeria have not been well documented. We assessed maternal health service utilization, predictors, and childbirth experiences amidst COVID-19 restrictions in a rural community of Kumbotso, Kano State, in northern Nigeria. Methods: Using an explanatory mixed methods design, 389 mothers were surveyed in January 2022 using validated interviewer-administered questionnaires, followed by in-depth interviews with a sub-sample (n=20). Data were analyzed using logistic regression models and the framework approach. Results: Less than one-half (n=165, 42.4%) of women utilized maternal health services during the period of COVID-19 restrictions compared with nearly two-thirds (n=237, 65.8%) prior to the period (p<0.05). Non-utilization was mainly due to fear of contracting COVID-19 (n=122, 54.5%), clinic overcrowding (n=43, 19.2%), transportation challenges (n=34, 15.2%), and harassment by security personnel (n=24, 10.7%). The utilization of maternal health services was associated with participant's post-secondary education (aOR=2.06, 95% CI:1.14- 11.40) (p=0.02), and employment type (civil service, aOR=4.60, 95% CI: 1.17-19.74) (p<0.001), business aOR=1.94, 95% CI:1.19- 4.12) (p=0.032) and trading aOR=1.62, 95% CI:1.19-2.94) (p=0.04)). Women with higher household monthly income (≥ N30,000, equivalent to 60 US Dollars) (aOR=1.53, 95% CI:1.13-2.65) (p=0.037), who adhered to COVID-19 preventive measures and utilized maternal health services before the COVID-19 pandemic were more likely to utilize those services during the COVID-19 restrictions. In contrast, mothers of higher parity (≥5 births) were less likely to use maternal health services during the lockdown (aOR=0.30, 95% CI:0.10-0.86) (p=0.03). Utilization of maternal services was also associated with partner education and employment type. Conclusion and Global Health Implications: The utilization of maternal health services declined during the COVID-19 restrictions. Utilization was hindered by fear of contracting COVID-19, transport challenges, and harassment by security personnel. Maternal and partner characteristics, adherence to COVID-19 preventive measures, and pre-COVID maternity service utilization influenced attendance. There is a need to build resilient health systems and contingent alternative service delivery models for future pandemics.

Perceived changes in the mental well-being among Nigerians due to Ramadan Intermittent Fasting during the COVID-19 pandemic.

INTRODUCTION: Muslims fast every year during the month of Ramadan from dawn until dusk. This study examined mental well-being and correlating factors among Nigerian adults who observed Ramadan intermittent fasting (RIF). METHODS: A validated generalized anxiety disorder-2 and Patient Health Questionnaire-2, the four-item spiritual well-being index, and the Islamic intrinsic religiosity questionnaire were used to collect data about mental well-being (depression, anxiety), spirituality, and intrinsic religiosity through a web-based survey between the May 9, 2021 (27th of Ramadan, 1442) and the June 4, 2021 (29th of Shawwal, 1442). We studied the mental well-being of respondents over a period of 4 weeks before Ramadan (BR) and during the 4 weeks of Ramadan between the April 12, 2021 and the May 12, 2021(DR). Multinomial regression analysis was used to determine the factors associated with depression and anxiety. This research did not receive any grant or funding. RESULTS: A total of 770 adult Nigerians who observed RIF study were included in this cross-sectional study. When compared to mental well-being BR, observing RIF by Nigerian adult respondents was associated with a significant improvement in their mental well-being. A higher proportion of respondents felt less depressed DR (61.3% vs. 56.5%. < .001). Interest and pleasure in doing things improved DR than BR (p= 0.007) and respondents felt less nervous and anxious (60.7% vs. 57.1%, respectively; p <.001). Mental well-being was independently associated with sociodemographic characteristics, physical activity, and perceived relationships. CONCLUSIONS: This study found significant improvement in mental well-being DR compared to BR despite the ongoing COVID-19 pandemic. The effect of RIF on mental well-being needs further research with multicentric studies among different sets of ethnic populations.

COVID-19 vaccine hesitancy among people living with HIV in a low-resource setting: A multi-center study of prevalence, correlates and reasons.

BACKGROUND: Hesitancy to COVID-19 vaccine may worsen the burden of COVID-19 among people living with HIV (PLHIV), who are at a higher risk of COVID-19-related hospitalization and death, compared to HIV non-infected individuals. Therefore, we evaluate the predictors and reasons for COVID-19 vaccine hesitancy among unvaccinated PLHIV in six antiretroviral therapy (ART) clinics across northern Nigeria. METHODOLOGY: In this cross-sectional study, conducted between October 2021 and February 2022 in six hospitals across two geopolitical regions of Nigeria, we utilized interviewer-administered questionnaires to assess COVID-19 vaccine hesitancy among a convenience sample of 790 eligible adult PLHIV. Hesitancy was defined as answering 'no' or 'maybe' to a question asking participants their willingness to accept the COVID-19 vaccine. A multivariate logistic regression model was used to estimate the adjusted odds ratio (aOR) and 95% confidence interval (CI) of the factors associated with COVID-19 vaccine hesitancy among PLHIV. RESULTS: Of the total 660 unvaccinated participants included in the analysis (61.82% female, mean age [SD] of 39.76 [10.75]), 381 (57.72%) were hesitant to COVID-19 vaccine. Being 50 years and older (aOR: 0.43; 95% CI: 0.21-0.89), being unemployed (aOR: 0.57; 95% CI: 0.34-0.95), experiencing the adverse effects of ART (aOR: 0.36; 95% CI: 0.15-0.86), and perception of being at high risk of contracting COVID-19 (aOR: 0.22; 95% CI: 0.13-0.37) were associated with significantly lower odds of hesitancy. Conversely, being female (aOR: 1.64; 95% CI: 1.02-2.61) and attending ART clinics at state administrative capital cities (IIDH Kano [aOR: 2.40; 95% CI: 1.10-5.25], MMSH Kano [aOR: 5.59; 95% CI: 1.97-10.66], YSSH Damaturu [aOR: 9.88; 95% CI: 4.02-24.29] vs. GH Gashua) were associated with significantly higher odds of hesitancy. The most common reasons for hesitancy include fear of potential adverse effects, skepticism about vaccine efficacy, the rapid development of the COVID-19 vaccine, and the perceived lack of effort to develop a cure or vaccine for HIV/AIDS. CONCLUSION: Interventions aimed at combating misperceptions and misinformation regarding the COVID-19 vaccination program may reduce the prevalence of COVID-19 vaccine hesitancy among unvaccinated PLHIV.

Examination of sleep in relation to dietary and lifestyle behaviors during Ramadan: A multi-national study using structural equation modeling among 24,500 adults amid COVID-19.

Background: Of around 2 billion Muslims worldwide, approximately 1.5 billion observe Ramadan fasting (RF) month. Those that observe RF have diverse cultural, ethnic, social, and economic backgrounds and are distributed over a wide geographical area. Sleep is known to be significantly altered during the month of Ramadan, which has a profound impact on human health. Moreover, sleep is closely connected to dietary and lifestyle behaviors. Methods: This cross-sectional study collected data using a structured, self-administered electronic questionnaire that was translated into 13 languages and disseminated to Muslim populations across 27 countries. The questionnaire assessed dietary and lifestyle factors as independent variables, and three sleep parameters (quality, duration, and disturbance) as dependent variables. We performed structural equation modeling (SEM) to examine how dietary and lifestyle factors affected these sleep parameters. Results: In total, 24,541 adults were enrolled in this study. SEM analysis revealed that during RF, optimum sleep duration (7-9 h) was significantly associated with sufficient physical activity (PA) and consuming plant-based proteins. In addition, smoking was significantly associated with greater sleep disturbance and lower sleep quality. Participants that consumed vegetables, fruits, dates, and plant-based proteins reported better sleep quality. Infrequent consumption of delivered food and infrequent screen time were also associated with better sleep quality. Conflicting results were found regarding the impact of dining at home versus dining out on the three sleep parameters. Conclusion: Increasing the intake of fruits, vegetables, and plant-based proteins are important factors that could help improve healthy sleep for those observing RF. In addition, regular PA and avoiding smoking may contribute to improving sleep during RF.

Prevalence, determinants, and reasons for malaria vaccine hesitancy among caregivers of under-five children in Nigeria: Results from a nationwide cross-sectional survey.

OBJECTIVE: Malaria contributes to an enormous global burden of disease and mortality, especially in children. Approximately one in every four global cases and deaths from malaria occurs in Nigeria. This study aims to evaluate the prevalence and correlates of community hesitancy to the malaria vaccine, including the reasons for the hesitancy, following the approval of the RTS,S malaria vaccine by the World Health Organization (WHO). METHODS: This was a nationwide cross-sectional online survey of Nigerian adults conducted from 20th October to 30th November 2021. Participants who replied 'no' or 'maybe' to a question assessing their willingness to accept the RTS,S malaria vaccine were considered "hesitant". We fit a multivariate logistic regression model to report the adjusted odds ratio (aOR) and 95 % confidence interval (CI) for the factors associated with vaccine hesitancy. FINDINGS: Among 3377 total respondents (1961 [57.86 %] males; mean age [SD]: 30[9.1]), 1010 (29.91 %) were hesitant. Receiving information about the RTS,S malaria vaccine initially from healthcare workers (vs. the internet) (aOR:0.55; 95 % CI:0.35-0.87) was significantly associated with lower odds of hesitancy. Conversely, earning a high income of over NGN100, 000 (vs. < NGN 30,000) per month (aOR: 2.10, 95 % CI: 1.36-3.24), belonging to other religious groups (vs. Islam) (aOR:3.25, 95 % CI:1.18-8.98), and having a family size of more than ten (vs. < 5) (aOR:1.84; 95 % CI:1.08-3.13) were significantly associated with a higher odds of hesitancy. The main reasons for vaccine hesitancy included fear of vaccine adverse effects (34.95 %), availability of other malaria preventive measures (33.96 %) and not seeing the positive effect of the vaccine in others first (32.97 %). CONCLUSION: The findings of this survey provide a valuable blueprint for the development of targeted interventions to facilitate caregiver acceptance of the RTS,S vaccine.

Improvised bubble continuous positive airway pressure ventilation use in neonates in resource-limited settings: a systematic review and meta-analysis.

OBJECTIVES: In the face of limited fiscal and technical resources, improvised methods have been used to provide effective and sustainable ventilatory support in low-resource settings to reduce neonatal mortality associated with respiratory complications. This study assessed the use of improvised bubble continuous positive airway pressure (ibCPAP) ventilation among neonates with respiratory complications and determined its effect on neonatal outcomes in low- and middle-income countries (LMICs). CONTENT: Hospital-based studies conducted between 2010 and 2020 in LMICs were reviewed. Rayyan® software for systematic review was used for screening and article selection. We used Stata® Statacorp Texas USA software to estimate pooled prevalence, proportion estimates, weighted mean differences and 95% Confidence Interval (CI), using the random effects model. SUMMARY: A total of 193 articles were generated and 125 were reviewed. Thirteen articles with 806 neonates on ibCPAP ventilation were included. The pooled prevalence of ibCPAP use was 7.0% (95% CI: 3.0%-13.0%). There was a significant difference in mean oxygen saturation before and after ibCPAP use (-1.34% [95% CI: -1.65% to -1.02%, p<0.01). The duration of oxygen requirement among neonates on ibCPAP was 6.5 hours less than controls (0.27 days [95%CI: -0.49 to -0.05, p<0.01). OUTLOOK: IbCPAP had no effect on the respiratory rate, duration of admission, mortality and survival. IbCPAP use in LMIC hospitals is low and its use improved oxygen saturation and duration on oxygen among the neonates, but had no impact on length of stay, respiratory rate, mortality or survival.

Knowledge of Personal Hygiene Among Street Food Vendors and Canteen Food Handlers in Kano: A Mixed Methods Study.

Background: The burden of food-borne diseases is becoming a global problem. The aim of this study was to assess and compare personal hygiene knowledge among street food vendors and canteen food handlers in the Kano metropolis. Methodology: An explanatory sequential mixed methods study was carried out using a structured interviewer-administered questionnaire, focus group discussion guide and observation checklist, to assess and compare personal hygiene knowledge among street food vendors and canteen food handlers in Kano metropolis, Nigeria. Quantitative data was analyzed at univariate, bivariate and multivariate levels using SPSS version 20.0 at a 5% α level of significance. Thematic analysis was used to analyze verbatim transcripts from qualitative interviews. Results: The response rates were 305/310 (98.4%) and 288/310 (92.9%) among street food vendors and canteen food handlers, respectively. The proportions of street food vendors and canteen food handlers with poor, fair and good knowledge of personal hygiene were (29.5% versus 19.8%), (51.8% versus 54.2%) and (18.7% versus 26.0%), respectively (p=0.009). There was a statistically significant association between education and knowledge of personal hygiene among street food vendors (p=0.03) and canteen food handlers (p=0.04). Though slightly better among canteen food handlers, narratives by the two groups of food handlers pointed to the general lack of awareness of basic personal hygiene which was supported by the findings from observation. Conclusion: Personal hygiene knowledge was poor among the two groups of food handlers; therefore, the Government should ensure legislation and enforcement involving training of food vendors, periodic medical examination, and issuance of fitness certificate to all food vendors.

Socio-demographic and Nutritional Factors Associated with Obesity amongst Adults from High Burden Kidney Diseases Areas of Jigawa State, Nigeria: A Community-based Survey.

Background: Obesity is a preventable public health problem associated with a significantly increased risk of non-communicable diseases. This study aimed to find the socio-demographic and nutritional factors associated with obesity amongst adults from high-burden kidney disease areas of Jigawa State, Nigeria. Methodology: A cross-sectional survey was conducted to assess the socio-demographic and nutritional factors associated with obesity among 361 adults from four local government areas (LGAs) of Jigawa state identified to have a high burden of kidney diseases. The Modified WHO STEPS questionnaire and multi-stage sampling technique were employed, and data were analyzed using IBM SPSS version 22.0. Results: The minimum age of the respondents was 18, and the maximum was 102 with a median of 45 (interquartile range = 30-80) years. The prevalence of obesity and overweight in the high-burden LGAs of Jigawa state was 33.0% and 27.1% respectively. Hadejia LGA had the highest (68.1%) prevalence of obesity. The prevalence of overweight was higher in Jahun LGA (38.9%). About one-third (38.2%) had a waist circumference (WC) greater than 88cm. Up to half of the female respondents had a waist-hip ratio (WHR) greater than 0.85. For male respondents, many (74.3%) had a WHR of greater than 0.9, and obesity was significantly higher (39.8%, P s< 0.001) among those ≥40 years of age. Obesity was significantly higher (39.8%,P < 0.001) among those ≥40 years of age, known diabetic, (57.1%, P=0.02), and rare consumption of vegetables, (45.8%, P<0.001).The odds of developing obesity were significantly higher among those who were known diabetics and were 3 times more likely to be obese than those who were not known to be diabetics (adjusted odds ratio [aOR] = 3.1, 95% CI = [1.1-8.9]. Conclusions: The prevalence of obesity was high in the areas with high burdens of kidney disease. The government and relevant stakeholders should develop a cost-effective prevention, early diagnosis, and treatment model.

A systematic review and meta-analysis of the prevalence of caregiver acceptance of malaria vaccine for under-five children in low-income and middle-income countries (LMICs).

INTRODUCTION: Malaria is the second leading cause of death in children after diarrheal disease, with low- and middle-income countries (LMICs) accounting for over 9 in 10 incidence and deaths. Widespread acceptance and uptake of the RTS,S vaccine, recently approved by the world health organization (WHO), is projected to significantly reduce malaria incidence and deaths. Therefore, we conducted this systematic review and meta-analysis with the aim to determine the malaria vaccine acceptance rate and the factors associated with acceptance. METHODS: We searched six databases including Google Scholar, PubMed, Cochrane, African Index Medicus, The Regional Office for Africa Library, and WHO Institutional Repository for Information Sharing (IRIS) to identify studies evaluating the malaria vaccine acceptance rate. This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Studies were included if they were original articles published in the English language in peer-reviewed journals and assessed the prevalence of willingness to accept a free malaria vaccine, and not qualitative. The risk of publication bias was checked using both Beggar's funnel plot and Egger's test, while the I2 statistic was used to assess the heterogeneity of the included studies. Study quality was determined using the Newcastle-Ottawa scale. A meta-analysis was performed using a random effects model to evaluate the pooled prevalence of malaria vaccine acceptance. The protocol for this article was registered prospectively on the International Prospective Register for Systematic Reviews (PROSPERO), with ID number CRD42022334282). RESULTS: Our analysis included 11 studies with a total sample size of 14, 666 participants. The aggregate malaria vaccine acceptance rate was 95.3% (95% CI:93.0%-97.2%). Among the general population, the acceptance rate was 96.3% (95% CI:92.0%-99.0%) and among mothers, it was 94.4% (95% CI:90.8%-97.2%). By country, Nigeria had the highest acceptance rate (97.6%, 95% CI:96.0%-98.8%), followed by Ghana (94.6%, 95% CI:93.8%-95.3%) and Tanzania (92.5%, 95% CI:84.4%-97.8%). Sociodemographic determinants of vaccine acceptance included place of residence, tribe, age, sex, occupation, and religion. Reasons for low acceptance included safety concerns, efficacy profile, vaccine's requirement for multiple injections, and poor level of awareness. CONCLUSION: Future efforts should be focused on identifying factors that may improve the actual uptake of the RTS,S vaccine in malaria-endemic communities.

Nigerian Muslim's Perceptions of Changes in Diet, Weight, and Health Status during Ramadan: A Nationwide Cross-Sectional Study.

The Islamic month of Ramadan is marked by fasting, when Muslims refrain from eating and drinking from dawn to sunset, which has an impact on their dietary habits. The study aimed to assess Nigerian Muslims' dietary modifications during Ramadan and their related changes in body weight and health status. A web-based cross-sectional study was conducted among Nigerian adult Muslims. The survey assessed sociodemographic, dietary habits, eating behaviors, food choices, perceived weight changes, and health status. The logistic regression model was used to assess the predictors of weight change and perceived health status. There were 770 participants, 62.9% of whom were women, ranging in age from 18 to 60 years with a mean age of 27.7 ± 6.4 years. Fruits, palm dates, homemade foods, milk products, and vegetables were more frequently consumed. There were fewer energy drinks, pastries, salty snacks, and carbonated or sugared drinks consumed during Ramadan than before. Over half (54.6%, 95% CI: 51.0-58.9%) of the respondents lost weight during Ramadan, 37.0% (95% CI: 17.4-38.6%) maintained their weight and 8.4% (95% CI: 6.6-10.6%) gained weight during the month. Nearly all (97.3%, 95% CI: 95.8-98.3%) reported having good health during Ramadan, and 2.7% (95% CI: 1.7-4.1%) reported having a poorer health state during Ramadan. There was a significant weight loss and healthy dietary change associated with Ramadan fasting in Nigeria. Public health measures must be in place to impart such positive health behaviors so that such healthy habits continue throughout the year.

"I Would Rather Take the Vaccine Than Undergo Weekly Testing": Correlates of Health Workers' Support for COVID-19 Vaccine Mandates.

This study examined the support for vaccine mandates and uptake among clinical and non-clinical staff at a tertiary hospital in northern Nigeria, focusing on variation of survey responses based on job position, socio-demographic characteristics, and perceived risk of infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Using an explanatory, sequential, mixed-methods design and deploying a pragmatic paradigm, 370 healthcare workers were administered structured questionnaires. This was followed by in-depth interviews with a sub-sample of respondents to further clarify the responses regarding support for the coronavirus disease 2019 (COVID-19) vaccine mandate. Findings demonstrated that less than one-half of respondents supported the COVID-19 mandate, and only one in three had received the recommended COVID-19 vaccine doses. Support for the vaccine mandate and vaccine uptake were predicted by profession, work experience, number of children, health status, and risk perception. Support for the vaccine mandate was ascribed to ethical and professional duty, whereas opposition was associated with respect for autonomy and human rights. This study documents the need to enhance support for vaccine mandates and uptake among healthcare workers through sustainable strategies, as Nigeria's healthcare workers are considered a source of trust and role models for the rest of society.