Nigeria's public health response to the COVID-19 pandemic: January to May 2020

The novel coronavirus disease 2019, COVID-19, which is caused by severe acute respiratory syndrome virus 2 (SARS-CoV-2) [1] was first reported in December 2019 by Chinese Health Authorities following an outbreak of pneumonia of unknown origin in Wuhan, Hubei Province [2,3]. SARS-CoV-2 is likely of zoonotic origin, similar to SARS and Middle East Respiratory Syndrome (MERS), and transmitted between humans through respiratory droplets and fomites. Since its emergence, it has rapidly spread globally [4]

Geographical drivers and climate-linked dynamics of Lassa fever in Nigeria

Lassa fever is a longstanding public health concern in West Africa. Recent molecular studies have confirmed the fundamental role of the rodent host (Mastomys natalensis) in driving human infections, but control and prevention efforts remain hampered by a limited baseline understanding of the disease's true incidence, geographical distribution and underlying drivers. Here, we show that Lassa fever occurrence and incidence is influenced by climate, poverty, agriculture and urbanisation factors. However, heterogeneous reporting processes and diagnostic laboratory access also appear to be important drivers of the patchy distribution of observed disease incidence. Using spatiotemporal predictive models we show that including climatic variability added retrospective predictive value over a baseline model (11% decrease in out-of-sample predictive error). However, predictions for 2020 show that a climate-driven model performs similarly overall to the baseline model. Overall, with ongoing improvements in surveillance there may be potential for forecasting Lassa fever incidence to inform health planning

COVID-19 mortality rate and its associated factors during the first and second waves in Nigeria

COVID-19 mortality rate has not been formally assessed in Nigeria. Thus, we aimed to address this gap and identify associated mortality risk factors during the first and second waves in Nigeria. This was a retrospective analysis of national surveillance data from all 37 States in Nigeria between February 27, 2020, and April 3, 2021. The outcome variable was mortality amongst persons who tested positive for SARS-CoV-2 by Reverse-Transcriptase Polymerase Chain Reaction. Incidence rates of COVID-19 mortality was calculated by dividing the number of deaths by total person-time (in days) contributed by the entire study population and presented per 100,000 person-days with 95% Confidence Intervals (95% CI). Adjusted negative binomial regression was used to identify factors associated with COVID-19 mortality. Findings are presented as adjusted Incidence Rate Ratios (aIRR) with 95% CI. The first wave included 65,790 COVID-19 patients, of whom 994 (1∙51%) died; the second wave included 91,089 patients, of whom 513 (0∙56%) died. The incidence rate of COVID-19 mortality was higher in the first wave [54∙25 (95% CI: 50∙98–57∙73)] than in the second wave [19∙19 (17∙60–20∙93)]. Factors independently associated with increased risk of COVID-19 mortality in both waves were: age ≥45 years, male gender [first wave aIRR 1∙65 (1∙35–2∙02) and second wave 1∙52 (1∙11–2∙06)], being symptomatic [aIRR 3∙17 (2∙59–3∙89) and 3∙04 (2∙20–4∙21)], and being hospitalised [aIRR 4∙19 (3∙26–5∙39) and 7∙84 (4∙90–12∙54)]. Relative to South-West, residency in the South-South and North-West was associated with an increased risk of COVID-19 mortality in both waves. In conclusion, the rate of COVID-19 mortality in Nigeria was higher in the first wave than in the second wave, suggesting an improvement in public health response and clinical care in the second wave. However, this needs to be interpreted with caution given the inherent limitations of the country’s surveillance system during the study

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

A cholera outbreak in a rural north central Nigerian community: an unmatched case-control study

Abstract Background Cholera remains a disease of public health importance in Nigeria associated with high morbidity and mortality. In November 2014, the Nigeria Field Epidemiology and Laboratory Training Programme (NFELTP) was notified of an increase in suspected cholera cases in Gomani, Kwali Local Government Area. NFELTP residents were deployed to investigate the outbreak with the objectives of verifying the diagnosis, identifying risk factors and instituting appropriate control measures to control the outbreak. Methods We conducted an unmatched case-control study. We defined a cholera case as any person aged ≥5 years with acute watery diarrhea in Gomani community. We identified community controls. A total of 43 cases and 68 controls were recruited. Structured questionnaires were administered to both cases and controls. Four stool samples from case-patients and two water samples from the community water source were collected for laboratory investigation. We performed univariate and bivariate analysis using Epi-Info version 7.1.3.10. Results The mean age of cases and controls was 20.3 years and 25.4 respectively (p value 0.09). Females constituted 58.1% (cases) and 51.5%(controls). The attack rate was 4.3% with a case fatality rate of 13%. Four stool (100%) specimen tested positive for Vibrio cholerae. The water source and environment were polluted by indiscriminate defecation. Compared to controls, cases were more likely to have drank from Zamani river (OR 14.2, 95% CI: 5.5–36.8) and living in households(HH) with more than 5 persons/HH (OR 5.9, 95% CI: 1.3–27.2). Good hand hygiene was found to be protective (OR 0.3, 95% CI: 0.1–0.7). Conclusion Vibrio cholerae was the cause of the outbreak in Gomani. Drinking water from Zamani river, living in overcrowded HH and poor hand hygiene were significantly associated with the outbreak. We initiated hand hygiene and water treatment to control the outbreak

Participatory approach to quality development in infection prevention and control (IPC) in Nigerian health facilities

The development of an educational concept of a training programme for infection prevention and control (IPC) was seen as a key issue to successfully address the complexity of change processes of professional IPC routines in clinical procedures. Therefore, the Nigeria Centre for Disease Control (NCDC), Nigeria, and the Robert Koch Institute (RKI), Germany established an interdisciplinary project framework, involving knowledge and competences from different disciplines and professions like health professionals, epidemiologists and educators (MAURICE project). A multi-module training programme for health care workers to improve IPC standards was developed and implemented based on the participatory approach and a systemic view for organizational change.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

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