A survey of chloroquine use for prevention and treatment of COVID-19 in Nigeria.

Background: Rampant chloroquine/hydroxychloroquine poisoning in Nigerian hospitals following suggestions of its possible efficacy in the treatment and prevention of the newly emerged COVID-19 disease informed this survey. Objectives: The aim of this study was to assess the knowledge, attitude and perception of the Nigerian populace on the use of chloroquine in the COVID-19 pandemic. Methods: This cross-sectional study was done by administering an electronic questionnaire created using Google Docs, through social media cascade methods including the WhatsApp application software to capture data on chloroquine use between April 20 and June 20, 2020. Results: Six hundred and twenty-eight people responded to the questionnaire (response rate 99.2%, mean age 41.05 ± 12.3) from the six geopolitical zones in Nigeria with 556 (88.5%) having tertiary level education. Only 21 (3.3%) of the respondents took chloroquine for treatment or prevention. Respondents from the North-west geopolitical zones used chloroquine 5.8 (95% CI: 1.55, 21.52, p=0.02) more times than other zones while the age group 20-29 were 8.8 times more likely to use chloroquine than any other age group (95% CI: 3.53, 21.70, p = 0.00). Female respondents were 2.3 times more likely to use chloroquine than the males (OR 2.26 95% CI: 0.90-5.68; p=0.08) and those in the income bracket of N75,000-99,000, 2.5 times more than other income groups. Conclusion: Young adults, North-western geopolitical zone, and female gender should be target groups for education on rational chloroquine use. The danger of chloroquine overdose should be communicated to the general population in Nigeria.

Knowledge, attitudes and perception of communities on mosquitoes and its control practices in Lagos State, Nigeria.

INTRODUCTION: evidence-based mosquito control strategy is important for efficient and effective delivery of mosquito control interventions. This is hinged on effective community participation and thorough understanding of the Knowledge Attitude and Practices (KAPs) to achieve desired result. Such community dynamics are often understudied. We designed this study to assess the perception of four local communities on aspects of mosquito behavior, prevention and control in Lagos State, Nigeria. METHODS: a cross-sectional survey was carried out using pretested semi-structured questionnaires to assess socio-demographic factors and KAPs in Kosofe, Alimosho, Ibeju-Lekki and Badagry Local Government Areas of Lagos State, Nigeria. Data analysis was carried out using IBM SPSS version 23. RESULTS: a total of 746 questionnaires were analyzed. Socio-demographic profile of the sampled population reveals that majority of the study population (73.1%) was between 18 and 40 years which constitute 49% males and 51% females. The knowledge of mosquito as a disease vector was high among the respondents which correlates with their level of education (P<0.05). The use of insecticide aerosols and Insecticides Treated Nets (ITNs) are the main control measures employed for mosquito control by respondents. Cost, convenience of usage and awareness majorly influenced the type of control measures that respondents adopt. Reasons such as not being easy to setup, skin irritation and the filling of being caged are reasons why some individuals do not use ITNs. Indoors, 32.4% of the respondents indicate the use of dichlorvos (DDVP) for household control of mosquitoes. CONCLUSION: the knowledge of mosquito control is high among middle aged individuals in Lagos State. Insecticide aerosols and ITNs are two major mosquito control methods used with DDVP insecticides frequently used indoors. This can inform the design of appropriate control methods in Lagos State.

Community Knowledge, Attitude and Practices on Malaria Vector Control Strategies in Lagos State, South-West Nigeria.

Malaria is a leading public health challenge causing mortality and morbidity in sub-Saharan Africa. Prominent malaria vector control methods employed in sub-Saharan Africa include Long Lasting Insecticide Nets (LLINs) and Indoor Residual spraying (IRS). This study investigated knowledge, attitude and practices (KAP) of malaria vector control methods in Lagos, South-West Nigeria. Structured questionnaires were employed for the cross-sectional survey which was carried out between May and August 2018. Multi-stage sampling technique was used to select Lagos Mainland, Kosofe, and Ojo local government areas (LGAs). Five hundred and twenty questionnaires were used for the study. Data were analyzed for descriptive statistics, whereas χ 2 was used to determine influence of respondents' LGA, level of education and type of dwelling on respondents' attitude and practice. Respondents' LGAs have no significant impact on attitude and practice to malaria vector control methods. However, 'level of education' as well as 'type of dwelling structure' impacted significantly on some practices and attitude. Basically, IRS is the major tool employed in malaria vector control, but sometimes it is used in combination with other methods. A good number of residents also use LLINs. 'Choice of method' employed is mainly based on the effectiveness of method. General perception about LLINs and IRS is that they are effective, cheap and safer. Considering the widespread use of IRS and LLINs for malaria vector control in Lagos, implementation of malaria control programs should consider KAP to these two strategies.

Impact of training of mothers, drug shop attendants and voluntary health workers on effective diagnosis and treatment of malaria in Lagos, Nigeria.

BACKGROUND: The National Malaria Eradication Program and international agencies are keen on scaling up the use of malaria rapid diagnostic tests (mRDTs) and artemisinin-based combination therapies (ACTs) for effective diagnosis and treatment of the disease. However, poor diagnostic skills and inappropriate treatment are limiting the efforts. In Nigeria, a large proportion of infected patients self-diagnose and treat while many others seek care from informal drug attendants and voluntary health workers. AIMS: This study describes the impact of training voluntary health workers, drug shop attendants, and mothers on effective case detection and treatment of malaria in Lagos, Nigeria. METHODS: We trained mothers accessing antenatal care, drug shop attendants, and voluntary health workers selected from the three districts of Lagos, on the use of histidine-rich protein-2-based mRDTs and ACTs. Pre- and post-training assessments, focus group discussions (FGDs), and in-depth interviews (IDIs) were carried out. RESULTS: The knowledge, attitude, and skill of the participants to achieve the goal of "test, treat, and track" using mRDT and ACTs were low (11%-55%). There was a low awareness of other non-malaria fevers among mothers. Self-medication was widely practiced (31.3%). FGDs and IDIs revealed that health-care providers administered antimalarials without diagnosis. Training significantly improved participants' knowledge and expertise on the use of mRDTs and ACTs (P = 0.02). The participants' field performance on mRDT use was significantly correlated with their category (bivariate r = 0.51, P = 0.001). There was no statistically significant association between the participants' level of education or previous field experience and their field performance on mRDT (r = 0.12, P = 0.9; χ 2= 38, df = 2 and P = 0.49). CONCLUSION: These findings suggest that training of stakeholders in malaria control improves diagnosis and treatment of malaria. However, a broader scope of training in other settings may be required for an effective malaria control in Nigeria.

Outcome of capacity building intervention for malaria vector surveillance, control and research in Nigerian higher institutions.

BACKGROUND: Despite the availability of effective malaria vector control intervention tools, implementation of control programmes in Nigeria is challenged by inadequate entomological surveillance data. This study was designed to assess and build the existing capacity for malaria vector surveillance, control and research (MVSC&R) in Nigerian institutions. METHODS: Application call to select qualified candidates for the capacity building (CB) intervention training programme was advertised in a widely read newspaper and online platforms of national and international professional bodies. Two trainings were organized to train selected applicants on field activities, laboratory tools and techniques relevant to malaria vector surveillance and control research. A semi-structured questionnaire was administered to collect data on socio-demographic characteristics of participants, knowledge and access of participants to field and laboratory techniques in MVSC&R. Similarly, pre and post-intervention tests were conducted to assess the performance and improvement in knowledge of the participants. Mentoring activities to sustain CB activities after the training were also carried out. RESULTS: A total of 23 suitable applicants were shortlisted out of the 89 applications received. The South West, South East and North Central geopolitical zones of the country had the highest applications and the highest selected number of qualified applicants compared to the South South and North East geopolitical zones. The distribution with respect to gender indicated that males (72.7%) were more than females (27.3%). Mean score of participants' knowledge of field techniques was 27.8 (± 10.8) before training and 67.7 (± 9.8) after the training. Similarly, participants' knowledge on laboratory techniques also improved from 37.4 (± 5.6) to 77.2 (± 10.8). The difference in the mean scores at pre and post-test was statistically significant (p < 0.05). Access of participants to laboratory and field tools used in MVSC&R was generally low with insecticide susceptibility bioassays and pyrethrum spray collection methods being the most significant (p < 0.05). CONCLUSIONS: The capacity available for vector control research and surveillance at institutional level in Nigeria is weak and require further strengthening. Increased training and access of personnel to relevant tools for MVSC&R is required in higher institutions in the six geopolitical zones of the country.

Knowledge, attitude and practice on malaria prevention and sulfadoxine-pyrimethamine utilisation among pregnant women in Badagry, Lagos State, Nigeria.

Background: Malaria in pregnancy is one of the major causes of mater nal morbidity and mortality as well as of poor pregnancy outcomes. We studied the knowledge, attitude and practices of pregnant women on malaria prevention, assessed their knowledge of sulfadoxine-pyrimethamine (SP) for intermittent preventive therapy in pregnancy (IPTp-SP), and used the outcomes to create awareness on malaria prevention with IPTp-SP. Materials and methods: A structured questionnaire on malaria prevention and SP utilisation was administer ed to 450 pregnant women attending antenatal clinics in both government and private health facilities in Badagry, Lagos State, Nigeria. Results: 355 (78.8% ) of the pregnant women perceived malaria as a serious illness. Other responses by the respondents included: parasitic disease (13; 2.9%); caused by mosquito (5; 1.9%), while 77 (17%) said they did not know. The signs and symptoms of malaria mentioned included headache (109; 24.2%), weakness (77; 17.1%), fever (77; 17.1%) and body pains (44; 10%). 174 (58%) women indicated that they would go to a hospital when having malaria, 54 (17%) indulged in self-medication, while 32 (11%) took herbs. 43 (14%) did nothing. Malaria prevention was performed by taking herbs (134; 30%); artemisinin-based combination therapy (ACT) (123; 27%); daraprim (104; 23%); blood tonic (51; 11%); paracetamol (21; 5%) and SP (17; 4%). Mosquito control was mainly carried out by the use of insecticide spray (215; 47.7%), followed by anti-mosquito coils (95; 21%). Out of the 450 pregnant women interviewed, 350 (84.5%) said that SP was for the treatment of malaria, while 69 (15.2%) said that it was for malaria prevention. Knowledge of SP was influenced by both education (P<0.05) and parity (P<0.001). Conclusion: The majority of the pregnant women had knowledge of SP but did not know that it is used for malaria prevention. Most of the respondents took malaria-preventive measures by taking herbs but preferred to go to the hospital when suspecting that they had malaria.

Perception and affordability of long-lasting insecticide-treated nets among pregnant women and mothers of children under five years in Ogun State, Nigeria.

Despite the distribution of long-lasting insecticide-treated nets (LLINs) in Nigeria, access to and use of LLINs continues to be minimal. Little is also known about the perceived fair price people are willing to pay for LLINs in Ogun State, South-West Nigeria. Data were collected using semi-structured questionnaire among pregnant women attending antenatal clinics and mothers of under-five children in randomly-selected malaria holo-endemic communities of Ijebu North and Yewa North local government areas of Ogun State. Results showed that only 23.6% of 495 respondents owned and were using LLINs. One of the main reasons for non-use of LLINs was unaffordability of LLIN cost. 84.2% of the 495 respondents were willing to pay at a hypothetical price of N800.00 (US$5.00) for a LLIN, 15.6% were unwilling and 0.2% was indifferent to buying it at the price. Their willingness to pay was significantly determined by education and occupation (p=0.00). Health education strategies need to be developed to increase awareness and demand for LLINs. However, there is the need to take into account preferred access outlets and the diversity in willingness to pay for LLINs if equity to access is to be ensured in the study communities.

Awareness of antimalarial policy and use of artemisinin-based combination therapy for malaria treatment in communities of two selected local government areas of Ogun State, Nigeria.

With limited data on the awareness of changes in the use of antimalaria drugs and availability and use of artemisinin-based combination therapy (ACT) in the context of the Roll Back Malaria (RBM) program, we conducted this descriptive cross-sectional study of 262 registered women attending antenatal clinics and 233 mothers of under-five children. We used a questionnaire to assess the awareness, availability and use of ACT in Ijebu North and Yewa North Local Government Areas (LGAs) of Ogun State. Malaria is holo-endemic in these areas, and the RBM program has been implemented for years prior to the 2010 RBM deadline. Data were also collected through focus group discussions, along with secondary data from hospital records. Hospital stock records showed inadequate and inconsistent supplies of ACT drugs in hospitals surveyed. Only 23.0% of respondents knew about ACT drugs. About 48% preferred analgesics over ACT drugs (0.6%) for malaria treatment. Lack of awareness was the major reason for non-use of ACT drugs (86.1%). Communities in Yewa North had more supplies of ACT drugs and knew more about ACT than those in Ijebu North. Adequate information on ACT needs to be made available and accessible under a public-private partnership if 2010 RBM targets (now past) and the 2015 Millennium Development Goal (ongoing) for malaria are to be realized in the study communities and Ogun State in general.

Molecular characterization of the circulating strains of Vibrio cholerae during 2010 cholera outbreak in Nigeria.

This study aimed at characterizing the phenotypic and toxigenic status of circulating strains of cholera during outbreaks in Nigeria, employing molecular typing techniques. Two hundred and one samples of rectal swabs, stool, vomitus, water (from the well, borehole, sachet, stream, and tap) and disinfectants (sodium hypochlorite) were collected from three states in the country. The samples were inoculated on thiosulphate-citrate bile salt-sucrose (TCBS), Cary-Blair transport medium and smeared on glass slides for direct examination. The Vibrio cholerae isolates were serotyped, biotyped, and characterized using PCR of the cytotoxin gene A (ctxA), wbeO1, and wbfO139 gene primer. Of the 201 samples screened, 96 were positive for V cholerae O1 (48%), with 69 (72%) positive for ctxA gene. The results from this study showed that the circulating strains of cholera in Nigeria were of Ogawa serotype, also observed in other outbreaks in Nigeria (1991, 1992, and 1996). However, the strains were of the Classical biotype and were mainly (72%) ctxA gene-positive. This current investigation has confirmed the production of cholera toxin by the circulating strains, and this could be harnessed for possible cholera vaccine production in Nigeria.

Survey of Hypertension, Diabetes and Obesity in Three Nigerian Urban Slums.

BACKGROUND: Non-communicable diseases (NCDs) exist in slums as the inhabitants adopt an urbanized lifestyle which places them at a higher risk for. Lack of knowledge about the morbidity, complications and the method of control contributes to a large percentage of undetected and untreated cases. METHODS: This cross-sectional survey polled 2,434 respondents from Ijora Oloye, Ajegunle and Makoko, three urban slums in Lagos metropolis, southwestern Nigeria between June 2010 and October 2012. We investigated the prevalence of hypertension, diabetes and obesity. Respondents signed consent forms and their health conditions were documented based on self-reported history of diabetes, hypertension and family history using a semi-structured questionnaire. Diagnostic tests; weight and height for body mass index, blood glucose, and blood pressure were performed. RESULTS: More than one quarter of the participants were suffering from hypertension and only half of this were diagnosed earlier, while a further few were already on treatment. Therefore on screening, it had been possible to diagnose over three hundred more respondents, who were not previously aware of their health status. The respondents' BMI showed that more than half of them were either overweight or obese and are at risk for diabetes, while 3.3% were confirmed as being diabetic, with their sugar levels greater than the normal range. CONCLUSION: This study therefore revealed the near absence of screening programs for chronic diseases such as hypertension, diabetes and obesity in these urban slums. This was further confirmed by the detection of new and undiagnosed cases of hypertension in about one quarter of the respondents.

An assessment of the emergency response among health workers involved in the 2010 cholera outbreak in northern Nigeria.

BACKGROUND: The 2010 cholera outbreak in northern Nigeria affected over 40,000 people, with a case fatality rate (CFR) of ≥3.75%. We assessed the emergency response of health care workers (HCWs) involved in case management. METHOD: This was a cross-sectional study with data collected through a self-administered questionnaire. Data entry and analysis were performed using Epi info software. RESULTS: A total of 56 HCWs were interviewed. The mean age was 31 years (SD±8.16 years). The majority of the HCWs (80%; n=45) were aged 18-39 years. Most were community health extension workers (60%), and 3.6% (n=2) were medical doctors. Many of the HCWs had less than 2 years of work experience (42%). Additionally, 82% of the respondents had <1 week of cholera emergency response training, and 50% of the HCWs managed >20 suspected cases of cholera per day. Although 78% of HCWs reported the practice of universal safety precautions, 32% (n=18) knew HCWs who developed symptoms of cholera during the epidemic, most of which was believed to be hospital acquired (78%). We also found that 77% (n=43) of HCWs had no access to the required emergency response supplies. CONCLUSION: Inadequate training, a lack of qualified HCWs and a limited supply of emergency response kits were reported. Therefore, the government and stakeholders should address the gaps noted to adequately control and prevent future epidemics.

Molecular characterization of Salmonella spp directly from snack and food commonly sold in Lagos, Nigeria.

Food borne Salmonella infection is an important cause of morbidity and mortality. A total of 200 food samples commonly sold in Lagos, Nigeria comprising raw and cooked meat as well as meat products and spoilt meat were analysed for the presence of Salmonella spp using REVEAL serology kit, culture methods employing RPVA (Rappaport Vassiliadis agar), SSA (Salmonella-Shigella agar) and BSA (brilliant sulphite agar) and PCR method for direct detection from samples using primer salm3/4 and ST11/ST15 sets. Using the REVEAL serology kit, 74% of the samples were positive for Salmonella spp, while culture methods showed only 19% to be Salmonella spp. The PCR method revealed that Salmonella spp was present in 62% and 54% of the samples using primer set salm3/4 and ST11/ST15, respectively. However, the primer set ST11/ST15 was more reliable in the identification of Salmonella spp directly from food samples. These tools should prove useful in the continuous monitoring and control strategies especially for ready-to-eat foods, as well as in retail meat outlets, slaughter houses, fast food restaurants for the prevention and reduction of this pathogen that is of significant importance in the food industry.

Prevalence of Schistosoma haematobium Infection in a Neglected Community, South Western Nigeria

Purpose: Schistosomiasis ranks second to malaria among parasitic diseases of socio-economic and public health importance. In Nigeria; urinary schistosomiasis caused by Schistosoma haematobium is endemic. This study aimed at producing an accurate data on the prevalence of urinary schistosomiasis in Apojula; a neglected community located around Oyan Dam; southwest Nigeria; using parasitological and molecular techniques. Methods: Parasitological examinations were carried out on urine samples from 63 participants whose ages ranged between 7 and 63 years. Matched blood and urine samples were also screened for S. hematobium infection by polymerase chain reaction (PCR) amplification of the schistosome Dra1 repeat. Results: of the 63 participants; 33 (52.4) were positive for heamaturia while 6 (9.5) had S. haematobium ova in their urine. PCR amplification of S. haematobium Dra1 repeat from their urine and blood samples showed that 59 (93.65) and 62 (98.4) were infected respectively. Conclusion: There was a high prevalence of S. haematobium infection as detected by PCR amplification of schistosome Dra1 repeat from the urine and blood samples of the study participants. In addition; the PCR was able to detect schistosome infection in cases otherwise shown to be negative by parasitological examinations thereby making them also to receive chemotherapy

Perceptions of the benefits and affordability of antiretrovirals among HIV-positive persons in a rural area of South-West Nigeria.

To assess the affordability of antiretroviral drugs (ARVs) and accessibility to treatment for opportunistic infections (OIs) among HIV-1 seropositive persons, we used semi-structured interviewer-administered questionnaires to interview 154 individuals seeking ARV treatment at the Daughter of Charity German Leprosy and Tuberculosis Centre in South-West Nigeria. The respondents' mean age was 37 years (range 13-65 years) and their average monthly income was NGN9 603 (approx. US$73). One hundred and eleven respondents (72.1%) had sought care elsewhere before seeking ARV therapy: 67 (60.4%) from private hospitals, 26 (23.4%) from public hospitals, 17 (15.3%) from traditional healing homes, and one from an NGO; the remaining 43 (27.9%) had not sought medical care before ARV therapy. Thirty-nine respondents (25.3%) had symptomatic AIDS with evidence of opportunistic infections (OIs), and 115 (74.7%) were HIV-1 seropositive only. One hundred and twenty-six (81.8%) believed that ARV treatment would prolong their lives, of which 27 anticipated a cure for AIDS; eight (11.7%) had no knowledge of the benefits of ARV therapy, six (3.9%) had strong fears of stigmatisation and discrimination as a consequence of ARV therapy, and four (2.6%) did not express any opinion. Sixty-three respondents (40.9%) perceived the cost of ARVs as expensive and unaffordable, 58 (37.7%) wanted free drugs, 20 (12.9%) wanted to pay a maximum of NGN2 000 (US$15) for monthly supplies (while the actual cost was NGN13 000 or US$98), and 13 (8.5%) did not comment. There was a strong association between literacy level and knowledge of ARV therapy. The more educated tended to have higher incomes and their perception of ARV therapy was laudable despite having sought other treatment elsewhere, while the less educated tended to earn less and perceived ARV therapy as unaffordable, and therefore had not bothered to seek previous treatment. We urge that ARVs be made more affordable to enhance their accessibility and treatment compliance, especially among lower-income patients.

Knowledge and perception of HIV/AIDS among pregnant women attending antenatal clinics in Ogun State, Nigeria.

Mother-to-child transmission of HIV (MTCT) is responsible for more than 90% of the cases of HIV infection in infants and children in sub-Saharan Africa. Accurate data on the knowledge and perceptions of HIV/AIDS among women attending antenatal clinics in Nigeria are scarce. A cross-sectional survey of 804 women attending antenatal clinics in Ogun State, South-West Nigeria was done using interviewer-administered questionnaires. Approximately 90% of the women respondents had heard of HIV/AIDS, but only about 27% knew HIV could be transmitted from mother to child; of those, almost 94% believed in the reality of HIV disease; in contrast, the majority (64%) believed they were not at risk of HIV infection, and a slightly greater proportion (70%) did not understand the benefits of voluntary HIV counselling and testing (VCT). Nonetheless, almost 90% of respondents were willing to know their status following health education about VCT. Those that were older, attending public hospitals, and with a higher level of education had more knowledge and better perceptions about HIV. The results suggest an urgent need for public health education on HIV/AIDS and the benefits of VCT to control MTCT, particularly targeting young women and those with little or no education.