New trends in under-five mortality determinants and their effects on child survival in Nigeria: A review of childhood mortality data from 1990-2008

Under-five mortality in Nigeria has been reported to be on the decline, but the dynamics are yet to receive adequate attention. Thus the main objective of this study was to assess these factors and quantify their relative contributions to under-five mortality between 1990 and 2008. The Nigeria Demographic and Health Survey data for 1990, 2003 and 2008 were re-analysed to assess the trends in determinants of under-five mortality.Cox Regression model was applied to determine the relative contributions of each factor to the under-five mortality risk.The results showed there were improvements in maternal education (8.6%), childhood vaccination (17.7%), use of oral rehydration therapy (13.9%) and medical treatment of childhood illnesses(17.5%) over the 19-year period. There were declines in proportions with birth interval less than 24months (3.9%), access to improved sources of drinking water (24.2%), improved toilet facilities (9.0%) antenatal care (4.5%), skilled delivery (3.0%) while maternal age at childbirth remained unchanged. These factors increased the death hazards by 4.6% between 1990-2003 but decreased them by 12% between 2003 and 2008. It was concluded that Nigeria has recorded very minimal improvements in birth spacing and antenatal/delivery care. Poor access to potable drinking water and sewage disposal, and short birth intervals,are among the factors fueling childhood mortality risks. Further improvements in these environmental and health practices as well as other factors are recommended as strategies for promoting child survival in Nigeria

Short-term Persistence of Protective Maternally Acquired Immunity in Neonates Delivered by Primiparous Women in Ibadan, Nigeria

BACKGROUND: Unresolved questions remain concerning the protective effect and duration of immunity acquired from mothers. This study investigated persistence of immunity against tetanus in the first two weeks of life among neonates in Nigeria.METHODS: In a longitudinal study, 244 primiparous mothers and their newborns were consecutively recruited at 16 selected Primary Healthcare Centres in Ibadan, Nigeria. All the newborns were tested for protection against tetanus using a validated rapid diagnostic, “Tetanos Quick Sticks” (TQS) on days 1, 7 and 14. Persistent immunity was defined as positive TQS result on day-14. Data were analysed using descriptive statistics, Chi-square and logistic regression at p = 0.05.RESULTS: There were 137(56.1%) male neonates; 87.7% were delivered at ≥37weeks of gestation. The prevalence of protective immunity against tetanus (PIaT) among neonates on day-1 was 63.5%; 119 out of 153 neonates remained positive to TQS test by day-14, giving a persistence rate of 77.8%. Independent predictors of persistent PIaT were residence in urban area (OR = 9.66; 95% CI = 2.42-38.45), maternal age (OR = 2.06; 95% CI = 1.49-2.85) and gestational age (OR = 1.84; 95% CI = 1.23-2.74).CONCLUSION: Protective immunity against tetanus waned in some neonates over the first two weeks of life, and this decline was inversely related to maternal and gestational ages

Treatment outcomes among pulmonary tuberculosis patients at treatment centers in Ibadan, Nigeria

Objective : To assess treatment outcomes and determinants of outcome among tuberculosis patients. Design : A longitudinal study design involving a cohort of sputum smear-positive pulmonary tuberculosis patients at initiation of therapy, who were followed up to the end of treatment at eighth month. Setting : Tuberculosis treatment centers in Ibadan, Nigeria Results : A total of 1,254 patients were followed up with a mean age of 35.0\ub13.3 years. The percentages of patients with treatment outcomes assessed in the study were as follows: cure (76.6%), failure (8.1%), default (6.6%), transferred out (4.8%), and death (1.9%). The cure rate varied significantly between treatment centers from 40 to 94.4% (P< 0.05). The treatment centers located within the specialist health centers at Jericho and the University College Hospital had 50 and 75% cure rates, respectively. The mean age of cured patients was 31.2\ub13.1 years, which was significantly lower than the mean age of those with poor treatment outcomes (36.7\ub13.5 years; P< 0.05). Males had a higher risk of a poor treatment outcome (RR=1.8; 95% CI: 1.02-1.94) than females. Also, patients with a poor knowledge of tuberculosis had a higher risk of having a poor treatment outcome (RR=1.35; 95% CI: 1.25-1.62) compared to those with a good knowledge. Conclusion : Variations in health center treatment outcomes and poor knowledge of tuberculosis among patients suggest that poor program implementation quality may be a major modifiable determinant of treatment outcomes in our environment

Risk factors for road traffic accidents among drivers of public institutions in Ibadan, Nigeria

Recent studies have shown an increase in the rate of road traffic accident (RTA). Identifying the risk factors for this problem may provide a clue to possible effective intervention. This study aimed to determine the prevalence and risk factors for self reported RTA among drivers of educational institutions and make suggestions to promote safer driving. A cross sectional population study of motor vehicle drivers from the College of Medicine, University of Ibadan and University College Hospital (UCH) Ibadan was undertaken between December 2003 and January 2004. The study comprised of 99 motor vehicle drivers. 67 (67.7%) were from the College of Medicine, and 32 (32.3%) from the UCH. Response rate was 97.1%. All were males, aged 38 to 60 years, mean 50.1 \ub1 (SD= 4.8 years). The prevalence of self reported RTA was 16.2%. The cause of road traffic accidents included, mechanical fault (50%), bad road (12.5%). RTA prevalence was higher among older drivers (OR=1.7, 95%CI=0.5-5.9; P>0,05), drivers who had part time jobs (Odds ratio 2.6, 95% CI 1.1-6.3; X2 =4.5, P=0.03), and drivers with visual impairment (OR=1.6, 95% CI=0-9, X2 0.49, P > 0.05). The prevalence of RTA was lower amongst drivers who did not take alcohol, cola nut and other CNS stimulants while driving (OR 0.9, 95% CI=0.3-2.3, P >0.05). Regular maintenance of official vehicles and examination of drivers\u2019 eyes are recommended. Drivers should be discouraged from drugs and part jobs so as to ensure that they have enough time to rest and therefore prevent fatigue related RTA

Adverse Events Related to SARS-Cov-2 Vaccination: A Systematic Review and Meta-Analysis

Background: Vaccination has been adopted as a key public health strategy for combating the COVID-19 pandemic. The accelerated SARS-CoV-2 vaccines’ development had limited time for extensive investigation of the adverse events. The study aimed to assess the average adverse events rates in published COVID-19 vaccination studies. Subjects and Method: The study used systematic review and meta-analysis involving studies that reported adverse events following administration of any of the approved COVID-19 vaccines in humans. A highly specific search strategy was developed and implemented in PubMed. The core search string was “(COVID-19 OR COVID OR "coronavirus disease") AND vaccin* AND (side-effects OR "adverse events")”. Titles and abstracts were screened, and full texts of potentially relevant articles were retrieved. Data extracted included general study background, adverse events, and frequency of occurrence. Meta-analyses were conducted for adverse events reported by at least 5 studies. Meta-analysis of proportions was carried out using logit transformation with the generalized linear mixed model estimation method. Results: A total of 108 adverse events were reported in 15 studies observing 735,515 participants from 10 countries. The highest pooled prevalence rates were pain at injection site (67.2%; 95% CI= 46.49 to 82.86; I2= 99.9%, 11 studies, 670,557 participants), weakness/fatigue (41.88%; 95% CI= 26.82 to 58.61, I2= 99.9%, 13 studies, 671,045 participants), muscle/joint pain (28.95%; 95% CI= 16.95 to 44.86, I2= 99.9%, 13 studies, 672,791 participants), and headache (27.78%; 95% CI= 17.59 to 40.95, I2= 99.9%, 14 studies, 672,883 participants). Four cases of death were reported by two papers enrolling 711 patients with cancer or multiple sclerosis, three due to comorbid disease progression, and one case due to COVID-19. Forty-three cases of anaphylaxis were reported in three studies enrolling 68,218 participants. Conclusion: The most prevalent adverse events among recipient of SARS-CoV-2 vaccines were local and general systemic reactions. Keywords: COVID-19, SARS-CoV-2 vaccine, adverse events, meta-analysis, systematic review Correspondence: Segun Bello. Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Nigeria. Email: [email protected]

Adverse Events Related to SARS-Cov-2 Vaccination: A Systematic Review and Meta-Analysis

Background: Vaccination has been adopted as a key public health strategy for combating the COVID-19 pandemic. The accelerated SARS-CoV-2 vaccines’ development had limited time for extensive investigation of the adverse events. The study aimed to assess the average adverse events rates in published COVID-19 vaccination studies. Subjects and Method: The study used systematic review and meta-analysis involving studies that reported adverse events following administration of any of the approved COVID-19 vaccines in humans. A highly specific search strategy was developed and implemented in PubMed. The core search string was “(COVID-19 OR COVID OR "coronavirus disease") AND vaccin* AND (side-effects OR "adverse events")”. Titles and abstracts were screened, and full texts of potentially relevant articles were retrieved. Data extracted included general study background, adverse events, and frequency of occurrence. Meta-analyses were conducted for adverse events reported by at least 5 studies. Meta-analysis of proportions was carried out using logit transformation with the generalized linear mixed model estimation method. Results: A total of 108 adverse events were reported in 15 studies observing 735,515 participants from 10 countries. The highest pooled prevalence rates were pain at injection site (67.2%; 95% CI= 46.49 to 82.86; I2= 99.9%, 11 studies, 670,557 participants), weakness/fatigue (41.88%; 95% CI= 26.82 to 58.61, I2= 99.9%, 13 studies, 671,045 participants), muscle/joint pain (28.95%; 95% CI= 16.95 to 44.86, I2= 99.9%, 13 studies, 672,791 participants), and headache (27.78%; 95% CI= 17.59 to 40.95, I2= 99.9%, 14 studies, 672,883 participants). Four cases of death were reported by two papers enrolling 711 patients with cancer or multiple sclerosis, three due to comorbid disease progression, and one case due to COVID-19. Forty-three cases of anaphylaxis were reported in three studies enrolling 68,218 participants. Conclusion: The most prevalent adverse events among recipient of SARS-CoV-2 vaccines were local and general systemic reactions. Keywords: COVID-19, SARS-CoV-2 vaccine, adverse events, meta-analysis, systematic review Correspondence: Segun Bello. Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Nigeria. Email: [email protected]

Household possession, use and non-use of treated or untreated mosquito nets in two ecologically diverse regions of Nigeria – Niger Delta and Sahel Savannah

<p>Abstract</p> <p>Background</p> <p>Current use of treated mosquito nets for the prevention of malaria falls short of what is expected in sub-Saharan Africa (SSA), though research within the continent has indicated that the use of these commodities can reduce malaria morbidity by 50% and malaria mortality by 20%. Governments in sub-Sahara Africa are investing substantially in scaling-up treated mosquito net coverage for impact. However, certain significant factors still prevent the use of the treated mosquito nets, even among those who possess them. This survey examines household ownership as well as use and non-use of treated mosquito nets in Sahel Savannah and Niger Delta regions of Nigeria.</p> <p>Methodology</p> <p>This survey employed cross-sectional survey to collect data from households on coverage and use of mosquito nets, whether treated or not. Fever episodes in previous two weeks among children under the age of five were also recorded. The study took place in August 1 – 14 2007, just five months after the March distribution of treated mosquito nets, coinciding with the second raining period of the year and a time of high malaria transmission during the wet season. EPI INFO version 2003 was used in data analysis.</p> <p>Results</p> <p>The survey covered 439 households with 2,521 persons including 739 under-fives, 585 women in reproductive age and 78 pregnant women in Niger Delta Region and Sahel Savannah Region. Of the 439 HHs, 232 had any mosquito nets. Significantly higher proportion of households in the Niger Delta Region had any treated or untreated mosquito nets than those in the Sahel Savannah Region. In the Niger Delta Region, the proportion of under-fives that had slept under treated nets the night before the survey exceeded those that slept under treated nets in the Sahel Savannah Region. Children under the age of five years in the Niger Delta Region were four times more likely to sleep under treated nets than those in the Sahel Savannah Region.</p> <p>Conclusion</p> <p>This study found that despite the fact that treated nets were distributed widely across Nigeria, the use of this commodity was still very low in the Sahel Savannah region. Future campaigns should include more purposeful social and health education on the importance and advantages of the use of treated nets to save lives in the Sahel Savannah region of Nigeria.</p

Addressing the under-reporting of adverse drug reactions in public health programs controlling HIV/AIDS, tuberculosis and malaria: A prospective cohort study

Background Adverse Drug Reactions (ADRs) are a major clinical and public health problem world-wide. The prompt reporting of suspected ADRs to regulatory authorities to activate drug safety surveillance and regulation appears to be the most pragmatic measure for addressing the problem. This paper evaluated a pharmacovigilance (PV) training model that was designed to improve the reporting of ADRs in public health programs treating the Human Immunodeficiency Virus (HIV), Tuberculosis (TB) and Malaria. Methods A Structured Pharmacovigilance and Training Initiative (SPHAR-TI) model based on the World Health Organization accredited Structured Operational Research and Training Initiative (SOR-IT) model was designed and implemented over a period of 12 months. A prospective cohort design was deployed to evaluate the outcomes of the model. The primary outcomes were knowledge gained and Individual Case Safety Reports (ICSR) (completed adverse drug reactions monitoring forms) submitted, while the secondary outcomes were facility based Pharmacovigilance Committees activated and health facility healthcare workers trained by the participants. Results Fifty-five (98%) participants were trained and followed up for 12 months. More than three quarter of the participants have never received training on pharmacovigilance prior to the course. Yet, a significant gain in knowledge was observed after the participants completed a comprehensive training for six days. In only seven months, 3000 ICSRs (with 100% completeness) were submitted, 2,937 facility based healthcare workers trained and 46 Pharmacovigilance Committees activated by the participants. Overall, a 273% increase in ICSRs submission to the National Agency for Food and Drug Administration and Control (NAFDAC) was observed. Conclusion Participants gained knowledge, which tended to increase the reporting of ADRs. The SPHAR-TI model could be an option for strengthening the continuous reporting of ADRs in public health programs in resource limited settings