Six months of COVID-19 response in Nigeria: lessons, challenges, and way forward

Background: The declaration of COVID-19 as a public health emergency by the World Health Organization necessitated countries across the globe to implement response and mitigation measures. We aimed to assess the Nigerian government's response following six months of detection of COVID-19 in Nigeria. Methods: A narrative review of existing literature on the topic was done. The authors' opinion as experts supporting the COVID-19 pandemic response was included. The review and opinion were summarized, covering six months of the outbreak response in Nigeria. Results: Contact tracing commenced after identifying the index case of COVID-19 in Nigeria but has been faced with challenges such as inadequate equipment and shortage of funds. School closure was implemented barely three weeks after detecting the index case, but the resumption of terminal classes has been announced recently. The Nigerian government implemented restrictions on gatherings involving up to 11 people after three weeks following the detection of the index case of COVID-19. The lack of enforcement and supervision of gatherings and public events made many individuals disregard the restriction measures. Lockdowns on religious gatherings and public events have been recently eased nationwide, and regulatory measures have been put in place. The Nigerian government implemented bans on international travel from all countries, especially high-risk countries. However, the existence of porous borders limited success, which could have been obtained from the travel ban. Conclusion: COVID-19 mitigation measures should be implemented and reinforced as required nationwide and get provided the needed support.   References World Health Organization. COVID-19 public health emergency of international concern (PHEIC) global research and innovation forum, 2020 February 12. In: WHO 2020. Available from: https://www.who.int/publications/m/item/covid-19-public-health-emergency-of-international-concern-(pheic)-global-research-and-innovation-forum [Accessed on 26 August 2020].] European centre for disease prevention and control. COVID-19 situation updates worldwide, as of 26 August 2020. In: ECDC 2020. Available from: https://www.ecdc.europa.eu/en/geographical-distribution-2019-ncov-cases [ Accessed on 26 August 2020].] Nigeria centre for disease control. COVID-19 outbreak in Nigeria situation report. Abuja. In: NCDC. 2020 Contract No.: S/N: 001. Available from: https://covid19.ncdc.gov.ng/ [Accessed on 26 August 2020]. Ogundele K. UPDATED: FG places travel ban on China, Italy, US, UK, nine others. Punch Newspapers, 2020 Mar 18. Available from: https://punchng.com/breaking-fg-places-travel-ban-on-china-italy-us-uk-others/ [ Accessed on 26 August 2020] Presidential task force on COVID-19. Available from: https://statehouse.gov.ng/covid19/ [Accessed on 26 August 2020]. Okunola A. 5 Challenges facing health care workers in Nigeria as they tackle COVID-19. On 9 June 2020. In: Global citizen. Available from: https://www.globalcitizen.org/en/content/challenges-for-health-care-workers-nigeria-covid/ [Accessed on 26 August 2020]. Sessou E. COVID-19: Why we provided testing kits in Kano- ADF. 2020 May 8. In: Vanguard. Available from: https://www.vanguardngr.com/2020/05/covid-19-why-we-provided-testing-kits-in-kano-adf/ [Accessed on 26 August 2020]. Ilesanmi OS, Afolabi AA. Time to move from vertical to horizontal approach in our COVID-19 response in Nigeria. SciMed J. 2020; 2:28-29. https://doi.org/10.28991/SciMedJ-2020-02-S1-3. Olisa C. Covid-19: FG orders immediate shut down of all schools. 2020 March 20. In: Naira Metrics [Internet]. Available at: https://nairametrics.com/2020/03/20/covid-19-fg-orders-immediate-shut-down-of-all-schools/ [Accessed on 26 August 2020]. Adejayan G. COVID-19: Lagos decontaminates schools for partial resumption. On 1 August 2020 [cited 26 August 2020]. In: Within Nigeria. Available from: https://www.withinnigeria.com/2020/08/01/covid-19-lagos-decontaminates-public-schools-for-partial-resumption/ [Accessed on 26 August 2020]. Oyetimi K, Adewakun A. E-learning: How COVID-19 is reshaping education in Nigeria. On 10 April 2020. Publish In: MSN. Available at: https://www.msn.com/en-za/news/other/e-learning-how-covid-19-is-reshaping-education-in-nigeria/ar-BB12pMEd [Accessed on 26 August 2020]. Hale T, Webster S, Petherick A, Phillips T, Kira B. Oxford COVID-19 Government Response Tracker, Blavatnik School of Government. 2020 March 21. In: Our World in Data. Oxford COVID-19 government response tracker. Available from: https://ourworldindata.org/grapher/public-gathering-rules-covid?year=2020-08-26&time=2020-01-01.2020-08-04&region=Africa [Accessed on 26 August 2020]. Lagos police command enforces ban on social gatherings to prevent spread of coronavirus. On 22 March 2020. In Vanguard. Available from: https://www.vanguardngr.com/2020/03/lagos-police-command-enforces-ban-on-social-gatherings-to-prevent-spread-of-coronavirus/ [Accessed on 26 August 2020]. Donohue JM, Miller E. COVID-19 and School Closures. JAMA. 2020;324(9):845-847. https://doi.org/10.1001/jama.2020.13092 Sahara Reporters. Nigerian government lifts ban on religious gatherings, reduces curfew hours. On 1 June 2020. In: Sahara Reporters. Available from: http://saharareporters.com/2020/06/01/nigerian-government-lifts-ban-religious-gatherings-reduces-curfew-hours [Accessed on 26 August 2020]. COVID-19: Lagos reels out guidelines for reopening of Mosques, Churches. On 6 August 2020. In: Vanguard. Available from: https://www.vanguardngr.com/2020/08/covid-19-lagos-reels-out-guidelines-for-reopening-of-mosques-churches/ [Accessed on 26 August 2020]. Vanguard. Porous borders, cause of rise in COVID-19 cases — FG. On 3 April 2020. In: Vanguard [internet]. Available from: https://www.vanguardngr.com/2020/04/porous-borders-cause-of-rise-in-covid-19-cases-fg/ [Accessed on 26 August 2020]

The direct cost of care among surgical inpatients at a tertiary hospital in south west Nigeria

Introduction: This study was conducted to assess the direct cost of care and its determinants among surgical inpatients at university College Hospital, Ibadan. Methods: A retrospective review of records of 404 inpatients that had surgery from January to December, 2010 was conducted. Information was  extracted on socio-demographic variables, investigations, drugs, length of stay (LOS)and cost of  carewith a semi-structured proforma. Mean cost of care were compared using t-test and Analysis of  variance (ANOVA). Linear regression analysis was used to identify determinants of cost of care. Level of significance of 5% was used. In year 2010 $1 was equivalent to 150 naira ($1=₦ 150).Results: The median age of patients was 30 years with inter-quartile range of 13-42 years. Males were  257(63. 6%). The mean overall cost of care was ₦66,983 ± ₦31,985. Cost of surgery is about 50% of total cost of care. Patient first seen at the Accident and Emergency had a significantly higher mean cost of care of ß = ₦17,207(95% CI: ₦4,003 to ₦30,410). Neuro Surgery (ß=₦36,210), and Orthopaedic Surgery versus General Surgery(ß=₦10,258),and Blood transfusion (ß=₦18,493) all contributed to cost of care significantly. Increase of one day in LOS significantly increased cost of care by ₦2,372. 57. Conclusion: The evidence evaluated here shows that costs and LOS are interrelated. Attempt at reducing LOS will reduce the costs of care of surgical inpatient

A scope review on the global impact of COVID-19 lockdown on adolescents’ health

Background: The implementation of COVID-19 lockdown measures across the globe could affect adolescents’ health. Objective: This review was conducted to assess the impact of the COVID-19 lockdown on the health of the adolescents. Methodology: We conducted this study using the scope reviews methodological framework. We searched for articles on the effects of COVID-19 lockdown among adolescents on four databases; MedLine, PubMed, Directory of Open Access Journals and Google Scholar. Screening of articles was done for relevance to the study objective. Results: The positive effects of the COVID-19 lockdown on adolescents included increased physical activity for adolescents 17 years and below, increased resource mobilization for healthy lifestyle, and psychosocial support programs for schools. The negative effects of the lockdown period were decreased physical activity with resulting disruptive sleep patterns; increased screen time, behavioral addictive disorder from excessive use of the internet, increased levels of domestic abuse,and worsening of existing mental health disorders. Overall, the COVID-19 lockdown period has had considerable adverseeffects on adolescents’ health. Conclusion: To curb the negative effects of the COVID-19 lockdown, we recommend parental supervision of adolescents’ screen time. Adolescent health should be prioritized by policymakers to ensure that future lockdown does not adversely affect them. Keywords: Adolescent health; Coronavirus; COVID-19 lockdown

Prioritization of resource allocation amid the COVID-19 outbreak response in Nigeria

The COVID-19 pandemic has revealed the massive shortcomings of health systems globally, particularly in Nigeria with weak healthcare infrastructure, high population, and chronic high morbidity and mortality from the double burden of infectious and non-infectious causes. Many routine and elective services were suspended or withdrawn, and existing delivery approaches adapted to the evolving COVID-19 pandemic across all the states in Nigeria. Preventive programs such as screening were completely suspended. The vaccination schedules were missed for many children due to the closure of the immunization clinics. Many Nigerian children being liable to infections, alongside a reduction in the possibility of child survival. Funds to manage the COVID-19 pandemic were donated from internal organizations and corporate agencies. However, the modalities involved in the disbursement of these funds were not publicly revealed by the Nigerian government. Therefore, we recommend optimal allocation of inadequate health resources in ways that maximize health care delivery benefits to the greatest number of people, give priority to the worst off, ensure equality and promote continued care provision for non-COVID-19 conditions, including pregnancy and chronic conditions. To ensure the improved trust of Nigerians and donor agencies and organizations, accountability on all funds should be ensured by the Nigerian government. For this cause, such funds should be committed into the hands of trustworthy and expert finance managers and infectious disease experts

Treatment of malaria in pregnancy: Knowledge of community pharmacists in Ibadan, Nigeria

Purpose: To evaluate the knowledge of community pharmacists in the management of malaria in pregnancy and their adherence to the World Health Organisation (WHO) treatment guidelines. Methods: Questionnaires were administered to obtain information on knowledge and adherence to WHO guidelines. Respondents’ scores on a 12-item knowledge question on the management of malaria in pregnancy were categorized as good knowledge if ≥ 10, and poor knowledge if < 10. Descriptive statistics were used to summarise the data. Chi-square test was used to explore the association between sociodemographic characteristics and knowledge. Results: Pharmacists qualified within 10 years of the study period were 29 (48.3 %). Only 25 (31.3 %) of the pharmacists possessed an additional qualification to Bachelor of Pharmacy degree. Rapid diagnostic test kits (RDT) and light microscopy test (LMT) have been used by 51 (76.2 %) and 17 (28.8 %), respectively, to diagnose malaria. About three-quarters (71.3 %) had poor knowledge of the medication for the treatment of malaria in pregnancy. Knowledge score was neither significantly associated with the pharmacists’ years of qualification (p = 0.174) nor with possession of additional qualification (p = 0.334). Conclusions: There is a substantial gap in pharmacists’ knowledge on the management of malaria in pregnancy, revealing an urgent need for training and adherence of community pharmacists to World Health Organisation treatment guidelines to ensure the safety of pregnant women and the unborn baby

Evaluation of the effect of border closure on COVID-19 incidence rates across nine African countries: an interrupted time series study

Background: Border closure is one of the policy changes implemented to mitigate against coronavirus disease 2019 (COVID-19). We evaluated the effect of border closure on the incidence rate of COVID-19 across nine African countries. Methods: An interrupted time series analysis was used to assess COVID-19 incidence rates in Egypt, Tunisia, Democratic Republic of the Congo (DRC), Ethiopia, Kenya, Ghana, Nigeria, Senegal and South Africa (SA). Data were collected between 14 February and 19 July 2020 from online data repositories. The linear trend and magnitude of change were evaluated using the itsa function with ordinary least-squares regression in Stata with a 7-d deferred interruption point, which allows a period of diffusion post-border closure. Results: Overall, the countries recorded an increase in the incidence rate of COVID-19 after border closure. However, when compared with matched control groups, SA, Nigeria, Ghana, Egypt and Kenya showed a higher incidence rate trend. In contrast, Ethiopia, DRC and Tunisia showed a lower trend compared with their controls. Conclusions: The implementation of border closures within African countries had minimal effect on the incidence of COVID-19. The inclusion of other control measures such as enhanced testing capacity and improved surveillance activities will reveal the effectiveness of border closure measures

A systematic review of tobacco smoking cessation services in Africa: Practices and challenges faced by healthcare workers

Background: Tobacco smoking is a global public health challenge, resulting in an estimated loss of 1.4 trillion United States Dollars (USD), a preventable risk that can be achieved through tobacco cessation services. The study, therefore, aimed to review the most frequently used methods employed by healthcare workers (HCWs) in providing tobacco cessation services and reported challenges in Africa. Methods: A systematic review was conducted using five electronic databases (PubMed, Base, PsychInfo, Google Scholar, and African Journal Online) for published studies on HCW’s practices and challenges on tobacco cessation in Africa. We adopted a three-stage methodology to conduct the study, which identified articles using pre-defined key terms, screened articles to remove duplicates, and excluded irrelevant articles after reading the manuscripts’ titles and abstracts. Results: We reviewed articles and found that 35.0% to 83.0% of HCWs frequently asked their patients to quit smoking. Also, 14.9% of HCWs assisted smoking cessation among their patients, among whom 3.9% prescribed oral depressants and 2.8% prescribed Nicotine Replacement Therapy (NRT). Further, 17.0% of HCWs had guidelines to help patients to cease smoking. Challenges were lack of efficacy and training, lack of system support, low sense of responsibility by some physicians to incorporate the smoking cessation therapy to their patients, lack of attractive educational resources on smoking cessation, limited knowledge on effective intervention strategies, lack of guidelines, lack of specialists for smoking cessation, and unavailability of NRT. Conclusion: Follow-up should be commenced and intensified by HCWs for smoking cessation among tobacco smokers

Factors associated with episiotomy among parturients delivering in a tertiary care centre in Nigeria

Background: The use of routine episiotomy is now less favoured among obstetricians. Given considerable evidence, it use increases maternal morbidity without evidence to support maternal or neonatal benefit. Objectives: To determine the current rate of episiotomy among parturients delivering at Federal Medical Centre, Owo, Ondo State, Nigeria and to identify factors associated with episiotomy.Methods: The retrospective study was conducted using the delivery records between 1st January 2012 and 31st December 2012. Information was obtained from the delivery register and medical records. There were 802 booked patients who had singleton vaginal deliveries between the studied periods. A total of 728 of these patients’ case records were obtained for analysis using SPSS 17.Results: The incidence of episiotomy was 9.3%. Those age <20 years, nulliparous, those who had assisted breech and instrumental deliveries had more episiotomy (P <0.0001). All the instrumental deliveries and most assisted breech deliveries (67%) were taken by the doctors. Episiotomies were more common when doctors took deliveries (Doctor vs. Nurses: 28.6% vs. 5.8%) (P <0.0001).Conclusion: While this study has identified factors associated with episiotomy, the episiotomy rate remain within normal rate at the studied centre. It is pertinent that health care providers always bear in mind the standard indications for episiotomy. This will go a long way in reducing the episiotomy rate and maintaining the recommended WHO rate of 10%.

PATENT MEDICINE VENDORS’ PREPAREDNESS AND RESPONSE FOR THE PREVENTION AND CONTROL OF COVID-19 INFECTION IN A NORTH-CENTRAL STATE IN NIGERIA

Objective: This report aimed to determine the immediate effect of the IPC training on the knowledge and role of patent medicine vendors (PMV) in the COVID-19 outbreak response in Nigeria. Methods: We conducted a quasi-experimental study before and after the IPC training among 1076 PMV in Ilorin, Kwara state, Nigeria. Data analysis was done using SPSS version 23. Eight questions were asked, for which each was assigned a score of “1”. Participants who had scored&lt;50% were categorized as “Fail”, while those with scores ≥50% were categorized as “Pass” in both the pre and post-tests. The Chi-square test was used to test for the association between sociodemographic characteristics and performance of respondents in the pre-and post-IPC knowledge results, and paired t-test to test for significant differences between the pre and post-tests mean scores. The level of significance was set at p&lt;0.05 for all statistical tests. Results: The mean age of the 1076 respondents was 37.06±10.96, 463(43%) passed the pre-test, while 617 (57.3%) passed the post-test. The mean pre-test IPC training score was 3.1310±1.5631, while the mean post-test IPC training score was 3.7351±1.6028 (t=-11.337, p=&lt;0.001). In all, 617(57.3%) scored higher in posttest. Overall, 560 (92.41%) identified community sensitization and health education on COVID-19 preventive measures as roles of PMV. Conclusion: Regular trainings on COVID-19 preventive practices among PMV should be conducted. PMV should be empowered to sensitize and educate their clients on the prevention of COVID-19

The new norm in the management of COVID-19 positives: home-based care

Background: The Coronavirus disease (COVID-19) has disrupted health systems globally and locally. The increasing number of COVID-19 positives has overwhelmed healthcare facilities and health workers. Home-based care (HBC) is a new norm in the management of COVID-19 positives. We aimed to give insight into the HBC of COVID-19 positives in Nigeria. Methods: We conducted a descriptive review of the existing literature and summarized the authors' opinions regarding HBC in Nigeria. Results: HBC has increasingly gained recognition for the management of COVID-19 positives. The HBC of COVID-19 positives provides the opportunity for patient management under an atmosphere of emotional, physical, and spiritual fulfillment as required for quick recovery. Guidelines have been developed for HBC of COVID-19 positives; however, negligence to these measures has been noted. Conclusion: To ensure compliance and harness HBC's benefits, community leaders, religious organizations, civil-based organizations, and opinion leaders should be actively involved in HBC activities. Also, enforcement authorities such as the Civil Defence Corps could help to improve adherence to HBC restrictions