Primary Health Care in Nigeria: Strategies and constraints in implemntation

The Alma Ata declaration on Primary Health Care (PHC) which was made in 1978 is meant to address the main health problems in communities by providing promotive, preventive, curative and rehabilitative services. Nigeriawas among the 134 signatories to this invaluable idea. Subsequently,  several re-organization of the Nigeria health structure to align with the new vision were made. The implementation of PHC, primarily through services provided at the primary health centres, vary based on the type of PHC facility in Nigeria. Several other PHC services within the health precinct include community mobilization, service integration and selected PHC programmes under the auspices of international collaborators. This review therefore, looks at the strategic trends and constraints in the implementation of PHC in Nigeria since the Alma Ata declaration.Key Words: Primary Health Care, Strategies for implementation, Constraints, Alma Ata Declaration, Nigeria

Knowledge and application of infectious diseases control measures among Primary Care workers in Nigeria: The Lassa fever example

The objective of this study was to investigate the knowledge and practice of Lassa fever control among primary care health workers. The study was a cross-sectional survey of health workers in 34 primary care centres in Esan West and Esan Central Local Government Areas. The LGAs were selected from Lassa fever-endemic areas in the state and studied with 231 self-administered semi-structured questionnaires. The knowledge of respondents was assessed using a ten-question scoring system. Data was analyzed and presented in tables and figures. All respondents were aware of Lassa fever and 77.9% of them had good knowledge of the control of the disease while 9.1% had poor knowledge. There was no significant association between level of knowledge and designation of the health worker (χ2=8.99, df =4, p>0.05). Only 13.0% and 16.9% of them regularly practiced barrier-nursing and hand washing, respectively, as means of containing the spread of the infection. The level of general knowledge about Lassa fever was high. However, there was poor compliance with standard preventive practices. Therefore, sustained education and re-training of Health workers at the primary care level is required to curtail nosocomial transmission of the disease.Key words: Lassa fever, health worker, infection, disease control

Market Sanitation: A Case Study of Oregbeni Market Benin - City Edo State, Nigeria

Poor market sanitation is an intractable problem in Nigeria and has contributed to the spread of infectious diseases and environmental degradation. This study was undertaken to determine the awareness and practice of solid waste management in market places among market users. It involved 180 store owners and customers recruited from Oregbeni market in Benin City, Nigeria. They were administered questionnaires while an in depth interview was conducted with the waste managers in the market. Checklist was used to carry out observation of the market place sanitation status. The data obtained was then analyzed and compared using SPSS. The results showed that a high proportion of respondents were aware of improper waste management (133; 62.8%) and agreed (174; 96.7%) that it is associated with many risks. Despite this high level of awareness, the practice of open dumping of waste was prevalent (108; 60.0%). Interestingly, 96.1% expressed willingness to pay for an improved waste disposal system while 55.6% rated the existing system as poor. Our findings suggest therefore that there is an urgent needs to improve waste collection, and disposal at market places.Keywords: Market sanitation, Solid Waste Management, Health hazards, Environmental degradation

Chlamydia trachomatis IgG antibodies seroprevalence among students in two tertiary institutions in Anambra state, Nigeria: a comparative study

Chlamydia infection is a common sexually transmitted infection (STI) in humans caused by the bacterium Chlamydia trachomatis. This study assessed the seroprevalence of Chlamydia trachomatis antibodies among students in two tertiary institutions in Anambra State, Nigeria. It was a comparative cross-sectional survey using enzyme immunoassay kits for the determination of IgG class antibodies, while the multistage sampling technique was used in the selection of participants for the study. The overall prevalence of Chlamydia trachomatis antibodies observed in this survey was 14.3%, which was higher among students from the University (21.6%) than their counterparts from the College of Education (7.4%) (χ2=5.89, df=1p<0.015). Factors found to have significant effect on the seroprevalence of Chlamydia trachomatis in both institutions were: prior sexual exposure (p<0.05); unprotected sexual intercourse in the last one year (p<0.05); multiple sexual partners in the last one year (p<0.05); and presence of symptoms suggestive of STI (p<0.05). Among students in the College of Education, the place of residence significantly affected Chlamydia trachomatis seroprevalence with a preponderance towards students living off-campus (χ2=4.00, df-1, p<0.05). Hence, there is need to institute appropriate prevention and control measures against the transmission of the disease especially among those at risk of contracting the disease.Keywords: Chlamydia trachomatis, seroprevalence, sexual behaviour, students, tertiary institutions

Emergence and spread of two SARS-CoV-2 variants of interest in Nigeria.

Identifying the dissemination patterns and impacts of a virus of economic or health importance during a pandemic is crucial, as it informs the public on policies for containment in order to reduce the spread of the virus. In this study, we integrated genomic and travel data to investigate the emergence and spread of the SARS-CoV-2 B.1.1.318 and B.1.525 (Eta) variants of interest in Nigeria and the wider Africa region. By integrating travel data and phylogeographic reconstructions, we find that these two variants that arose during the second wave in Nigeria emerged from within Africa, with the B.1.525 from Nigeria, and then spread to other parts of the world. Data from this study show how regional connectivity of Nigeria drove the spread of these variants of interest to surrounding countries and those connected by air-traffic. Our findings demonstrate the power of genomic analysis when combined with mobility and epidemiological data to identify the drivers of transmission, as bidirectional transmission within and between African nations are grossly underestimated as seen in our import risk index estimates

Int J Infect Dis

Lassa fever (LF) is an endemic viral hemorrhagic fever in West Africa. Among the serious complications of the disease are neurological manifestations whose spectrum is incompletely known. Here we report the case of a 61-year-old man who developed a delayed-onset paraparesis a few weeks after getting infected with Lassa virus thereby suggesting a possible association between LF and spinal cord disorders

Circulation of Lassa virus across the endemic Edo-Ondo axis, Nigeria, with cross-species transmission between multimammate mice

ABSTRACTWe phylogenetically compared sequences of the zoonotic Lassa virus (LASV) obtained from Mastomys rodents in seven localities across the highly endemic Edo and Ondo States within Nigeria. Sequencing 1641 nt from the S segment of the virus genome, we resolved clades within lineage II that were either limited to Ebudin and Okhuesan in Edo state (2g-beta) or along Owo-Okeluse-Ifon in Ondo state (2g-gamma). We also found clades within Ekpoma, a relatively large cosmopolitan town in Edo state, that extended into other localities within Edo (2g-alpha) and Ondo (2g-delta). LASV variants from M. natalensis within Ebudin and Ekpoma in Edo State (dated approximately 1961) were more ancient compared to those from Ondo state (approximately 1977), suggesting a broadly east-west virus migration across south-western Nigeria; a pattern not always consistent with LASV sequences derived from humans in the same localities. Additionally, in Ebudin and Ekpoma, LASV sequences between M. natalensis and M. erythroleucus were interspersed on the phylogenetic tree, but those from M. erythroleucus were estimated to emerge more recently (approximately 2005). Overall, our results show that LASV amplification in certain localities (reaching a prevalence as high as 76% in Okeluse), anthropogenically-aided spread of rodent-borne variants amidst the larger towns (involving communal accommodation such as student hostels), and virus-exchange between syntopic M. natalensis and M. erythroleucus rodents (as the latter, a savanna species, encroaches southward into the degraded forest) pose perpetual zoonotic hazard across the Edo-Ondo Lassa fever belt, threatening to accelerate the dissemination of the virus into non endemic areas

Increase in Lassa Fever Cases in Nigeria, January–March 2018

We reviewed data pertaining to the massive wave of Lassa fever cases that occurred in Nigeria in 2018. No new virus strains were detected, but in 2018, the outbreak response was intensified, additional diagnostic support was available, and surveillance sensitivity increased. These factors probably contributed to the high case count

Epidemiologic and Clinical Features of Lassa Fever Outbreak in Nigeria, January 1–May 6, 2018

Lassa fever (LF) is endemic to Nigeria, where the disease causes substantial rates of illness and death. In this article, we report an analysis of the epidemiologic and clinical aspects of the LF outbreak that occurred in Nigeria during January 1–May 6, 2018. A total of 1,893 cases were reported; 423 were laboratory-confirmed cases, among which 106 deaths were recorded (case-fatality rate 25.1%). Among all confirmed cases, 37 occurred in healthcare workers. The secondary attack rate among 5,001 contacts was 0.56%. Most (80.6%) confirmed cases were reported from 3 states (Edo, Ondo, and Ebonyi). Fatal outcomes were significantly associated with being elderly; no administration of ribavirin; and the presence of a cough, hemorrhaging, and unconsciousness. The findings in this study should lead to further LF research and provide guidance to those preparing to respond to future outbreaks

A standardised Phase III clinical trial framework to assess therapeutic interventions for Lassa fever

Background Only one recommendation currently exists for the treatment of Lassa fever (LF), which is ribavirin administered in conjunction with supportive care. This recommendation is primarily based on evidence generated from a single clinical trial that was conducted more than 30 years ago–the methodology and results of which have recently come under scrutiny. The requirement for novel therapeutics and reassessment of ribavirin is therefore urgent. However, a significant amount of work now needs to be undertaken to ensure that future trials for LF can be conducted consistently and reliably to facilitate the efficient generation of evidence. Methodology We convened a consultation group to establish the position of clinicians and researchers on the core components of future trials. A Core Eligibility Criteria (CEC), Core Case Definition (CCD), Core Outcome Set (COS) and Core Data Variables (CDV) were developed through the process of a multi-stakeholder consultation that took place using a modified-Delphi methodology. Results A consensus position was achieved for each aspect of the framework, which accounts for the inclusion of pregnant women and children in future LF clinical trials. The framework consists of 8 core criteria, as well as additional considerations for trial protocols. Conclusions This project represents the first step towards delineating the clinical development pathway for new Lassa fever therapeutics, following a period of 40 years without advancement. Future planned projects will bolster the work initiated here to continue the advancement of LF clinical research through a regionally-centred, collaborative methodology, with the aim of delineating a clear pathway through which LF clinical trials can progress efficiently and ensure sustainable investments are made in research capacity at a regional level