A designathon to co-create HPV screening and vaccination approaches for mothers and daughters in Nigeria: findings from a community-led participatory event.

BACKGROUND: Oncogenic types of human Papillomavirus (HPV) infection cause substantial morbidity and mortality in Nigeria. Nigeria has low cervical cancer screening and vaccination rates, suggesting the need for community engagement to enhance reach and uptake. We organised a designathon to identify community-led, innovative approaches to promote HPV screening and vaccination for women and girls, respectively, in Nigeria. A designathon is a three-phase participatory process informed by design thinking that includes the preparation phase that includes soliciting innovative ideas from end-users, an intensive collaborative event to co-create intervention components, and follow-up activities. METHODS: We organised a three-phase designathon for women (30-65yrs) and girls (11-26yrs) in Nigeria. First, we launched a national crowdsourcing open call for ideas on community-driven strategies to support HPV screening among women and vaccination among girls. The open call was promoted widely on social media and at in-person gatherings. All eligible entries were graded by judges and 16 exceptional teams (with 4-6members each). All six geo-political zones of Nigeria were invited to join an in-person event held over three days in Lagos to refine their ideas and present them to a panel of expert judges. The ideas from teams were reviewed and scored based on relevance, feasibility, innovation, potential impact, and mother-daughter team dynamics. We present quantitative data on people who submitted and themes from the textual submissions. RESULTS: We received a total of 612 submissions to the open call from mother-daughter dyads. Participants submitted ideas via a website designated for the contest (n = 392), in-person (n = 99), email (n = 31), or via an instant messaging application (n = 92). Overall, 470 were eligible for judging after initial screening. The average age of participants for daughters was 19 years and 39 years for mothers. Themes from the top 16 proposals included leveraging local leaders (5/16), faith-based networks (4/16), educational systems (4/16), and other community networks (7/16) to promote awareness of cervical cancer prevention services. After an in-person collaborative event, eight teams were selected to join an innovation training boot camp, for capacity building to implement ideas. CONCLUSIONS: Innovative strategies are needed to promote HPV screening for mothers and vaccination for girls in Nigeria. Our designathon was able to facilitate Nigerian mother-daughter teams to develop cervical cancer prevention strategies. Implementation research is needed to assess the effectiveness of these strategies.

Sexual dysfunction among Nigerian women living with HIV infection.

INTRODUCTION: Sexual dysfunction in women with HIV is a necessary but understudied aspect of HIV complications in women living with HIV. This study reports the prevalence, pattern, and risk factors for sexual dysfunction in women living with HIV in southwest Nigeria. METHODS: A validated Female Sexual Function Index was used to determine sexual dysfunction in a cross-sectional study design involving 2926 adult women living with HIV in a large, publicly funded tertiary HIV treatment centre in Lagos, Nigeria. A score of less than 26.5 indicated sexual dysfunction. Multivariate logistic regression analysis was performed to identify risk factors for sexual dysfunction. P<0.05 was considered statistically significant at a 95% confidence interval (CI). RESULTS: The prevalence of sexual dysfunction was 71.4%. The types of dysfunctions detected included disorder of desire (76.8%), sexual arousal (66.0%), orgasm (50.0%), pain (47.2%), lubrication (47.2%), and satisfaction (38.8%). Multivariate analysis showed that menopause (aOR: 2.0; 1.4-4.1), PHQ score of 10 and above (aOR: 2.3; 1.7-3.2), co-morbid medical conditions (aOR: 1.8; 1.4-2.7), use of protease inhibitor-based antiretroviral therapy (aOR: 1.3; 1.2-2.1) and non-disclosure of HIV status (aOR: 0.7; 0.6-0.8) were factors associated with sexual dysfunction. CONCLUSIONS: Sexual dysfunction is common among Nigerian women living with HIV. Menopause, use of protease inhibitor-based regimens, PHQ score of at least 10, co-morbid medical condition, and non-disclosure of HIV status were associated with sexual dysfunction. National HIV programmes, in addition to incorporating screening and management of sexual dysfunction in the guidelines, should sensitise and train health workers on the detection and treatment of sexual dysfunction.

A designathon to co-create HPV screening and vaccination approaches for mothers and daughters in Nigeria: findings from a community-led participatory event.

Background: Oncogenic types of human Papillomavirus (HPV) infection cause substantial morbidity and mortality in Nigeria. Nigeria has low cervical cancer screening and vaccination rates, suggesting the need for community engagement to enhance reach and uptake. We organised a designathon to identify community-led, innovative approaches to promote HPV screening and vaccination for women and girls, respectively, in Nigeria. A designathon is a three-phase participatory process informed by design thinking that includes the preparation phase that includes soliciting innovative ideas from end-users, an intensive collaborative event to co-create intervention components, and follow-up activities. Methods: We organised a three-phase designathon for women (30-65yrs) and girls (11-26yrs) in Nigeria. First, we launched a national crowdsourcing open call for ideas on community-driven strategies to support HPV screening among women and vaccination among girls. The open call was promoted widely on social media and at in-person gatherings. All eligible entries were graded by judges and 16 exceptional teams (with 4-6members each). All six geo-political zones of Nigeria were invited to join an in-person event held over three days in Lagos to refine their ideas and present them to a panel of expert judges. The ideas from teams were reviewed and scored based on relevance, feasibility, innovation, potential impact, and mother-daughter team dynamics. We present quantitative data on people who submitted and themes from the textual submissions. Results: We received a total of 612 submissions to the open call from mother-daughter dyads. Participants submitted ideas via a website designated for the contest (n=392), in-person (n=99), email (n=31), or via an instant messaging application (n=92). Overall, 470 were eligible for judging after initial screening. The average age of participants for daughters was 19 years and 39 years for mothers. Themes from the top 16 proposals included leveraging local leaders (5/16), faith-based networks (4/16), educational systems (4/16), and other community networks (7/16) to promote awareness of cervical cancer prevention services. After an in-person collaborative event, eight teams were selected to join an innovation training boot camp, for capacity building to implement ideas. Conclusions: Innovative strategies are needed to promote HPV screening for mothers and vaccination for girls in Nigeria. Our designathon was able to facilitate Nigerian mother-daughter teams to develop cervical cancer prevention strategies. Implementation research is needed to assess the effectiveness of these strategies.

The Role of Multimicronutrient Supplementation in Pediatric HIV Management in Nigeria: A Randomized Controlled Study.

BACKGROUND: We aimed to compare the immunologic and hematologic effects of 3 multimicronutrient supplements in human immunodeficiency virus-positive children in Lagos, Nigeria. METHODS: This double-blind, randomized controlled study included 190 children, aged 5-12 years, in Lagos, Nigeria. Sixty-four, 63, and 63 participants were assigned to multimicronutrient group A, B, or C, respectively, for 6 months. Supplements A, B, and C contained 7 micronutrients at the recommended daily allowance (RDA) (comparable to standard-of-care multivitamin), 22 micronutrients at the RDA, and 22 micronutrients at 3 times the recommended daily allowance (3RDA), respectively. Using paired sample t tests and factorial repeat-measures analysis of variance (ANOVA), within- and between-group changes in CD4 count and hemoglobin levels were evaluated after 6 months. RESULTS: After 6 months of supplementation, paired-sample t test showed that CD4 cell count did not significantly differ from baseline for all 3 groups. Between-subject effect also did not significantly differ in the 3 groups after 6 months (factorial repeat-measures ANOVA (F [degrees of freedom {df} = 2, 187] = 0.846; P = .436; partial η 2 = 0.009). Hemoglobin levels were significantly increased after supplementation in all 3 supplement groups. Increases were not significantly different between groups (factorial repeat-measures ANOVA (F [df = 2, 187] = 0.549; P = .591; partial η 2 = 0.006). CONCLUSIONS: Equivalent effects were observed. After 6 months of supplementation, mean CD4 count was not significantly different between groups. Hemoglobin concentration was significantly increased in all 3 groups, but increase did not differ between groups. CLINICAL TRIALS REGISTRATION: NCT02552602.

Musculoskeletal symptoms and non-prescribed treatments are common in an urban African population of people living with HIV.

There are no data from West Africa reporting musculoskeletal (MSK) disease in people living with HIV (PLWH). Our primary outcome was to measure the prevalence of MSK symptoms in PLWH in urban West Africa. Our secondary outcomes were to describe the disability, impact on work and treatment use associated with the presence of MSK pain. We conducted an e-questionnaire-based point prevalence study of musculoskeletal symptoms, associated disability and treatment in 292 PLWH attending routine follow-up in Lagos, Nigeria. Seventy-three (25%) patients reported MSK pain; 28 (38%) reported chronic symptoms (> 3 months). HIV suppression rates were high in this population (n = 240, 82%) and comparable between individuals with and without chronic pain. MSK pain was associated with female gender and higher body mass index (BMI). Mechanical pain was the most common pain syndrome identified (n = 34, 47%). Lumbar spine and knee were the most common sites. Chronic pain was associated with increased disability compared with the presence of any MSK pain. High rates of treatment-seeking behaviour were seen in those individuals reporting MSK pain (n = 62, 85%). The majority of these individuals sought traditional treatments (n = 48, 66%). Chronic MSK pain and non-prescribed treatments are common in PLWH established on ART in urban West Africa. Studies are required to measure the long-term impact of these symptoms and medicines on retention in HIV care and ART adherence, besides other long-term health outcomes.

Child sexual abuse and disclosure in South Western Nigeria: a community based study.

INTRODUCTION: The true burden of child sexual abuse in Nigeria is not known as most reports are institutional based. This study was designed to determine population level data on the burden and pattern of child sexual abuse among adolescents in South Western Nigeria. METHODS: A community based study among adolescents in SouthWestern Nigeria. Semi- structured interviewer administered questionnaire was used to collect data from respondents selected through a multistage sampling technique. Analysis was with SPSS version 20. RESULTS: 398 adolescents (314 females and 84 males) aged 10-19 years with a mean age of 15.6 ± 2.0 years participated in the study. Most were single (90.7%), in school (84.2%), and lived with their parents/guardians (89.4%). The prevalence of CSA was 25.7%. Penetrative abuse occurred in 7.5%, and forced abuse in 46.2% of cases. Perpetrators were mostly boyfriends (31.2%) and neighbours (16.1%). Intra-familial abuse occurred in 7.5% of cases. Only 34.4% of cases ever disclosed the abuse. CONCLUSION: CSA is common in the community, with perpetrators majorly persons known to the adolescents. A large number of cases are not reported. Efforts should be made to educate children and their parents on various ways to reduce child sexual abuse and its consequences.

Prevalence and impact of sickle cell trait on the clinical and laboratory parameters of HIV infected children in Lagos, Nigeria.

INTRODUCTION: sickle cell disease and HIV infection are prevalent in sub-Saharan Africa. While Haemoglobin S (HbS) contributes to significant morbidity and mortality in the homozygous or double heterozygous states, in the carrier state it confers a survival advantage in disease conditions such as malaria. However the interaction between sickle haemoglobin and HIV infection, especially in children remains largely unknown. This study aimed to assess the prevalence and impact of sickle cell trait on the clinical and laboratory parameters of HIV infected children in Lagos, Nigeria. METHODS: a cross-sectional study among HIV infected children in an HIV treatment centre in Lagos, Nigeria. Socio-demographic and clinical characteristics were obtained and blood sample collected for haemoglobin electrophoresis, HIV RNA viral load and haematologic profile. Data was analysed with SPSS version 20. RESULTS: the prevalence of sickle cell trait was 18.8% among the 208 study participants, with none having sickle cell disease (SCD). Participants with SCT were significantly younger (OR = 4.0 95% CI (1.74-9.24)), more likely to be from the Yoruba ethnic group (OR = 3.3 95% CI [1.45-7.52)), had more opportunistic infections (OR = 2.4 95% CI (1.18-5.03), and lower mean HIV RNA viral load (p = 0.05) at baseline. However response to HIV care and treatment was similar in both groups of participants. CONCLUSION: the finding of absence of SCD, low prevalence of SCT, and lower HIV viraemia in HIV infected children with SCT may have implications for childhood survival which requires further clarification in future studies.

Trends and patterns of sexual assaults in Lagos south-western Nigeria.

INTRODUCTION: Sexual assault is a severely traumatic experience that disproportionally affects women and girls. Yet there is limited information on the subject in our environment. This study was conducted to determine the trend and pattern of sexual assault among Nigerians. METHODS: A retrospective study of sexual assault victims managed at a large clinic in south west Nigeria. Victims were identified from the programme data base and case files retrieved from medical records department. Relevant information was extracted and managed with SPSS for windows version 19. RESULTS: Steady increase in the proportion of reported cases of sexual violence over the years (P < 0.0001) was observed. Sexual assaults were recorded among the males (6.1%), although female victims were in the majority (93.9%). Sexual assault was found to be higher in person's <20 years and the unmarried. Most sexual assault occurred during the day time. Assailants were mostly persons known to the victim (52.0%) and the assault occurred mostly in the assailants' house or office (48.5%). Sexual assault through vaginal route only (87.2%) was the most common route of sexual assault. Threat of violence (31.1%) and physical force (29.6%) was the common methods for overcoming the victims. Follow up was completed by 75.0% of the victims. CONCLUSION: Sexual assault is common in our environment, with increasing prevalence and change in pattern. Young persons aged less than 20 years constitutes the majority of victims and assailants were mostly persons known to them. The current public education on the evils of sexual violence should be intensified.