Characteristics of COVID-19 cases and factors associated with their mortality in Katsina State, Nigeria, April-July 2020

Introduction: COVID-19 was first detected in Daura, Katsina State, Nigeria on 4 April 2020. We characterized the cases and outlined factors associated with mortality. Methods: We analysed the COVID-19 data downloaded from Surveillance Outbreak Response, Management and Analysis System between 4 April and 31 July 2020. We defined a case as any person with a positive SARS-CoV-2 test within that period. We described the cases in time, person, and place; calculated the crude and adjusted odds ratios and 95% confidence intervals for factors associated with mortality. Results: We analysed 744 confirmed cases (median age 35, range 1-90), 73% males and 24 deaths (Case fatality rate 3.2%, Attack rate 8.5/100,000). The outbreak affected 31 districts, started in week 14, peaked in week 26, and is ongoing. Highest proportion of cases in the age groups were 26.7% (184) in 30-39, 21.7% (153) in 20-29 years, and 18.3% (129) in 40-49 years. While the highest case fatality rates in the age groups were 35.7% in 70-79, 33.3% in 80-89 years, and 19.4% in 60-69 years. Factors associated with death were cough (AOR: 9.88, 95% CI: 1.29-75.79), age ≥60 years (AOR: 18.42, 95% CI: 7.48-45.38), and male sex (AOR: 4.4, 95% CI: 0.98-20.12). Conclusion: Male contacts below 40 years carried the burden of COVID-19. Also, persons 60 years and above, with cough have an increased risk of dying from COVID-19. Risk communication should advocate for use of preventive measures, protection of persons 60 years and above, and consideration of cough as a red-flag sign

Evaluation of the Measles Case-Based Surveillance System in Kaduna State (2010-2012)

Despite the high investment on Measles surveillance activities, frequent measles outbreaks still occur in Kaduna State. We evaluated the surveillance system to adentify gaps in its operations.We adapted the updated CDC guidelines on surveillance evaluation to assess the systems usefulness, representativeness, simplicity, timeliness, stability and acceptability. Our findings showed that the surveillance system is still useful however there were marked deficiencies in the timeliness and completeness of weekly reporting

Evaluation of the Measles Case-Based Surveillance System in Kaduna State (2010-2012)

Despite the high investment on Measles surveillance activities, frequent measles outbreaks still occur in Kaduna State. We evaluated the surveillance system to adentify gaps in its operations.We adapted the updated CDC guidelines on surveillance evaluation to assess the systems usefulness, representativeness, simplicity, timeliness, stability and acceptability. Our findings showed that the surveillance system is still useful however there were marked deficiencies in the timeliness and completeness of weekly reporting

Evaluation of the Measles Surveillance System in Kaduna State, Nigeria (2010-2012)

ObjectiveTo evaluate the case-based Measles surveillance system in Kaduna State of Nigeria and identify gaps in its operation.Introduction In Africa, approximately 13 million cases of measles and 650,000 deaths occur annually, with sub-Saharan Africa having the highest morbidity and mortality (1). Measles infection is endemic in Nigeria and has been documented to occur all year round despite high measles routine and supplemental immunisation coverage (2,3). The frequent outbreaks of Measles in Kaduna State prompted the need for the evaluation of the Measles case-based surveillance system.Methods We interviewed stake holders and  adapted the updated 2001 CDC guidelines on surveillance evaluation to assess the systems usefulness, representativeness, timeliness, stability and acceptability. A retrospective record review of the measles case-based surveillance data from 2010– 2012 was carried out to assess data quality and representativeness. We calculated the annualized detection rate of measles and non-measles febrile rash, proportion of available results, proportion of Districts (LGAs) that investigated at least one case with blood, proportion of cases that were IgM positive and the incidence of measles. We compared the results with WHO (2004) recommended performance indicators to determine the quality and effectiveness of measles surveillance system. Results According to the Stake holders, the case-based surveillance system is useful and acceptable. Median interval between specimen collection and release of result was 38  days (Range: 16 – 109) in 2011, 11 days (Range: 1 – 105) in 2012. The best median turnaround time of 7days (1 – 25) was recorded in 2010. The annualized detection rate of measles rash in 2011 was 1.0 (target: ≥2), in 2012 it was 1.4 (target: ≥2). The annualized detection rate of non-measles febrile rash in 2011 was 0.6 (target: ≥2) while it was 0.8 (target: ≥2) in 2012. Case definitions are simple and understood by all the operators. We found a progressive decline in  timeliness and data quality in the years under review.ConclusionThis evaluation showed that the surveillance system was still useful. Also, the efficiency and effectiveness of the laboratory component as captured by the “median interval between specimen collection and the release of results improved in 2010 and 2012 compared to 2011. However, there was a progressive decline in the timeliness and completeness of weekly reports in the years under review.Keywords:  Measles; Case-based; Surveillance; Evaluation; Nigeri

Evaluation of the Measles Surveillance System in Kaduna State, Nigeria (2010-2012)

ObjectiveTo evaluate the case-based Measles surveillance system in Kaduna State of Nigeria and identify gaps in its operation.Introduction In Africa, approximately 13 million cases of measles and 650,000 deaths occur annually, with sub-Saharan Africa having the highest morbidity and mortality (1). Measles infection is endemic in Nigeria and has been documented to occur all year round despite high measles routine and supplemental immunisation coverage (2,3). The frequent outbreaks of Measles in Kaduna State prompted the need for the evaluation of the Measles case-based surveillance system.Methods We interviewed stake holders and  adapted the updated 2001 CDC guidelines on surveillance evaluation to assess the systems usefulness, representativeness, timeliness, stability and acceptability. A retrospective record review of the measles case-based surveillance data from 2010– 2012 was carried out to assess data quality and representativeness. We calculated the annualized detection rate of measles and non-measles febrile rash, proportion of available results, proportion of Districts (LGAs) that investigated at least one case with blood, proportion of cases that were IgM positive and the incidence of measles. We compared the results with WHO (2004) recommended performance indicators to determine the quality and effectiveness of measles surveillance system. Results According to the Stake holders, the case-based surveillance system is useful and acceptable. Median interval between specimen collection and release of result was 38  days (Range: 16 – 109) in 2011, 11 days (Range: 1 – 105) in 2012. The best median turnaround time of 7days (1 – 25) was recorded in 2010. The annualized detection rate of measles rash in 2011 was 1.0 (target: ≥2), in 2012 it was 1.4 (target: ≥2). The annualized detection rate of non-measles febrile rash in 2011 was 0.6 (target: ≥2) while it was 0.8 (target: ≥2) in 2012. Case definitions are simple and understood by all the operators. We found a progressive decline in  timeliness and data quality in the years under review.ConclusionThis evaluation showed that the surveillance system was still useful. Also, the efficiency and effectiveness of the laboratory component as captured by the “median interval between specimen collection and the release of results improved in 2010 and 2012 compared to 2011. However, there was a progressive decline in the timeliness and completeness of weekly reports in the years under review.Keywords:  Measles; Case-based; Surveillance; Evaluation; Nigeri

Trends in Malaria Cases and Deaths: Assessing National Prevention and Control Progress in Burundi

Background: Malaria is associated with high morbidity and mortality especially in World’s tropical regions. In 2016, an estimated 216 million and 445,000 cases of malaria and deaths associated with malaria respectively were reported globally. Malaria is the first leading cause of outpatient visits, hospitalization and death in Burundi. We therefore examined the trend in malaria cases and deaths in Burundi.Methods: We extracted data from Burundi National Health Information System (BNHIS) and assessed trends in malaria cases and deaths from January 2015 to December 2017. A suspected case of malaria was defined as any person treated by anti-malarial drugs without testing while a confirmed case as any person with a positive microscopy or rapid diagnostic test for malaria parasite. We described malaria cases and deaths, and calculated malaria case incidence rate.Results: A total of22,225,699 malaria cases with 8,660 deaths (CFR 0.04%) was documented during the study period. Out of 22,225,699 cases, 45,291 cases (0.2%) were suspected malaria cases. The observed peak season of malaria infection in any of the studied year was in the raining season (March-June). All provinces of the country were affected. Kirundo and Cankuzo provinces the incidence of malaria cases increased from 10.1 cases per 1,000 persons in 2015 to 13.2 cases per 1,000 persons in 2017. The case fatality rate decreased from 0.06% in 2015 to 0.01% in 2017.Conclusions: An increasing trend in malaria prevalence was observed in Burundi but Kirundo and Cankuzo provinces were the most affected. However, the case fatality decreased within the studied period. Malaria intervention should be intensified/scaled up in the raining season and the most affected provinces

Drug-susceptible tuberculosis treatment outcomes and its associated factors among inmates in prison settings in Bauchi State, Nigeria, 2014-2018.

Tuberculosis (TB) is a contagious disease and its transmissibility is increased in congregate settings. TB incidence rates are five-to-fifty times higher among inmates in prison settings than the general population which has a direct impact on the outcome of TB treatment. There is paucity of information on TB treatment outcomes and its associated factors in Nigerian prison settings. We therefore assessed TB treatment outcomes among inmates in prison settings in Bauchi State, Nigeria. We conducted a retrospective data analysis of inmates with TB in the five-main prison settings in Bauchi State. We extracted socio-demographic, clinical and treatment outcome characteristics from TB treatment register of inmates treated for TB between January 2014 and December 2018, using a checklist. We calculated the TB treatment success rate (TSR) and explored the relationship between the TSR and socio-demographic and clinical characteristics. Related variables were modelled in multiple logistic regression to identify factors associated with TSR at 5% level of significance. All 216 inmates were male with mean (SD) age of 37.6±11.4 years. Seventy-six (35.2%) were cured, 61 (28.2%) completed treatment, 65 (30.1%) were transferred-out without evaluation and 14 (6.5%) died. Overall TSR was 72.9%. Factors associated with successful-treatment-outcome were age, weight, imprisonment duration and HIV status. The results indicate that inmates who are 20-29 years are at least ten times more likely to be successful (aOR = 10.5; 95%CI: 3.2-35.1) than inmates who are 55 years or older. Inmates who are 30-39 years are about four times more likely to be successful than inmates who are 55 years or older (aOR = 4.2; 95% CI: 1.3-13.1). In general, the younger an inmate, the more successful he is. Inmates with pretreatment-weight; 55kg or more are 13 times more likely to be successful (aOR = 13.3; 95%CI: 6.0-29.6) than inmates with weight below 55kg. Inmates who were imprisoned for 2 years or less are about three times more likely to be successful (aOR = 2.6; 95%CI: 1.3-5.4) than inmates who were imprisoned for more than 2 years and HIV negative inmates were three times more likely to succeed (aOR = 3.3; 95%CI:1.4-7.8) than inmates who were HIV positive. We recommended that to improve TB treatment outcome among inmates; age, duration-of-imprisonment, weight and TB/HIV co-infection should be the major consideration during pretreatment, psychological and nutritional counselling and a tracking-system be developed by the authority to follow-up inmates transferred-out to other health facilities to ensure they complete the treatment and outcomes evaluated

User Evaluation Indicates High Quality of the Surveillance Outbreak Response Management and Analysis System (SORMAS) After Field Deployment in Nigeria in 2015 and 2018

During the West African Ebola virus disease outbreak in 2014–15, health agencies had severe challenges with case notification and contact tracing. To overcome these, we developed the Surveillance, Outbreak Response Management and Analysis System (SORMAS). The objective of this study was to measure perceived quality of SORMAS and its change over time. We ran a 4-week-pilot and 8-week-implementation of SORMAS among hospital informants in Kano state, Nigeria in 2015 and 2018 respectively. We carried out surveys after the pilot and implementation asking about usefulness and acceptability. We calculated the proportions of users per answer together with their 95% confidence intervals (CI) and compared whether the 2015 response distributions differed from those from 2018. Total of 31 and 74 hospital informants participated in the survey in 2015 and 2018, respectively. In 2018, 94% (CI: 89–100%) of users indicated that the tool was useful, 92% (CI: 86–98%) would recommend SORMAS to colleagues and 18% (CI: 10–28%) had login difficulties. In 2015, the proportions were 74% (CI: 59–90%), 90% (CI: 80–100%), and 87% (CI: 75–99%) respectively. Results indicate high usefulness and acceptability of SORMAS. We recommend mHealth tools to be evaluated to allow repeated measurements and comparisons between different versions and users.Peer Reviewe

Factors associated with a confirmed Lassa fever outbreak in Eguare community of Esan West, Edo State, Nigeria: January-March, 2019

Introduction: Lassa fever disease is endemic in Edo State, Nigeria. A national upsurge in Lassa fever cases and death occurred in January 2019, with Eguare community in Esan West Local Government Area, Edo State having an unusual increase in number of reported cases. We investigated the outbreak to determine factors associated with being a confirmed Lassa fever case and the health seeking behaviour of the community members. Methods: We conducted an unmatched 1:4 case control study. We defined a confirmed case-patient as any person from Eguare community with febrile illness and PCR positive for Lassa fever between January and March, 2019; and control as anyone from Eguare community without febrile illness within the same period. Structured questionnaire was used to obtain data on exposures from both cases and controls. Univariate and bivariate analysis was done and confidence level set at 95%. Results:A total of 10 case-patients and 40 controls were recruited. The mean age of casepatients was 45.8years ± 15.2 and controls 35.6years ± 14.6. Forty percent of casepatients and 52.5% of controls were females. Having contact with suspected casepatients and having dumpsites close to homes (p<0.01) were associated with Lassa fever infection among case-patient. Eighty-six percent of the respondents would report at health facility if presented with febrile illness. Conclusion: Avoiding contact with a suspected Lassa fever case-patients and improved waste management system may prevent and interrupt the spread of Lassa fever virus