Descriptive epidemiology and mortality risk factors of COVID-19 outbreak in Delta State, Nigeria, March - August 2020

Introduction: The highly contagious Coronavirus Disease 2019 (COVID-19) was first confirmed in Nigeria on February 27, 2020. In Delta State, the first COVID-19 case was recorded on April 7, 2020, which spread across the state. We characterized the COVD-19 pandemic in Delta State in terms of person, place, and time, and determined the risk factors for COVID-19 mortality. Methods: We conducted a retrospective analysis of COVID-19 pandemic in Delta State between March 23 to August 17, 2020. We obtained line-lists of 5,917 COVID-19 patients, cleaned and analyzed sociodemographic, clinical characteristics and outcome variables using IBM SPSS Statistics 25. We calculated frequencies, proportions, mean and standard deviation (SD). Bivariate and multivariate logistics regression analysis were conducted to determine the risk factors of COVID-19 mortality, adjusted-odds-ratios were reported at 95% confidence interval and p-value set at 5% significance level. Results: From March-August 2020, 1,605 confirmed COVID-19 cases and 47 deaths (case-fatality-rate 2.9%) were recorded. Majority were aged 20-39 years 675 (42.1%) while 1,064 (66.3%) were males (mean age 39±15years). Persons aged ≥60years were more likely to die from COVID-19 than younger cases (aOR: 11.0; 95% CI: 4.9-24.4) while Symptomatic positive cases at time of test were more likely to die than those who were not (aOR: 3.2; 95% CI: 1.3-7.5). Conclusion: Males in the youthful age-group were mostly affected. Independent predictors of mortality were being elderly or symptomatic at time of testing. Strengthening case management to target symptomatic patients and intensifying sensitization activities targeting youthful males and elderly persons, are important to reduce mortality

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

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 case-patients was 45.8years ± 15.2 and controls 35.6years ± 14.6. Forty percent of case-patients and 52.5% of controls were females. Having contact with suspected case-patients 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

Organizational readiness to implement task-strengthening strategy for hypertension management among people living with HIV in Nigeria

Abstract Background Hypertension (HTN) is highly prevalent among people living with HIV (PLHIV), but there is limited access to standardized HTN management strategies in public primary healthcare facilities in Nigeria. The shortage of trained healthcare providers in Nigeria is an important contributor to the increased unmet need for HTN management among PLHIV. Evidence-based TAsk-Strengthening Strategies for HTN control (TASSH) have shown promise to address this gap in other resource-constrained settings. However, little is known regarding primary health care facilities’ capacity to implement this strategy. The objective of this study was to determine primary healthcare facilities’ readiness to implement TASSH among PLHIV in Nigeria. Methods This study was conducted with purposively selected healthcare providers at fifty-nine primary healthcare facilities in Akwa-Ibom State, Nigeria. Healthcare facility readiness data were measured using the Organizational Readiness to Change Assessment (ORCA) tool. ORCA is based on the Promoting Action on Research Implementation in Health Services (PARIHS) framework that identifies evidence, context, and facilitation as the key factors for effective knowledge translation. Quantitative data were analyzed using descriptive statistics (including mean ORCA subscales). We focused on the ORCA context domain, and responses were scored on a 5-point Likert scale, with 1 corresponding to disagree strongly. Findings Fifty-nine healthcare providers (mean age 45; standard deviation [SD]: 7.4, 88% female, 68% with technical training, 56% nurses, 56% with 1–5 years providing HIV care) participated in the study. Most healthcare providers provide care to 11–30 patients living with HIV per month in their health facility, with about 42% of providers reporting that they see between 1 and 10 patients with HTN each month. Overall, staff culture (mean 4.9 [0.4]), leadership support (mean 4.9 [0.4]), and measurement/evidence-assessment (mean 4.6 [0.5]) were the topped-scored ORCA subscales, while scores on facility resources (mean 3.6 [0.8]) were the lowest. Conclusion Findings show organizational support for innovation and the health providers at the participating health facilities. However, a concerted effort is needed to promote training capabilities and resources to deliver services within these primary healthcare facilities. These results are invaluable in developing future strategies to improve the integration, adoption, and sustainability of TASSH in primary healthcare facilities in Nigeria. Trial registration NCT05031819