HIV/AIDS: Are Our Secondary School Students in Zaria Metropolis Receiving Adequate Communication from Their Families?

Introduction: Nigeria has one of the highest proportions of cases of HIV/AIDS globally. This burden is more pronounced in the younger population which includes secondary school students (SSS). We set out to  determine the level of family communication among SSS in Zaria metropolis. Subjects and Methods: We carried out a cross‑sectional study among 73 randomly selected students. Data were obtained with a semi‑structured, pretested, self‑administered questionnaire. Descriptive statistics were used to present data at the univariate level while Chi‑square or Fisher’s exact test was employed to identify the relationship between non-numeric variables with a 5% level of significance. Results: The mean age (± standard deviation) was 16.1 ± 1.1 years. Majority have heard 60 (82.2%) and have good knowledge 55 (75.3%) of family communication. There was an overall positive attitude as 44 (60.3%)  believe it helps prevent HIV/AIDS and 57 (78.1%) believe it is very important and should be encouraged. Most (57 [78.1%]) have had family communication, with mother as the preferred partner 49 (86%). HIV/ AIDS (44 [77.2%]) was the major issue discussed. We out that found the knowledge of family communication was  significantly associated with its practice (P = 0.018). Conclusion: Awareness, knowledge, attitude, and practice of family communication were good among respondents. Father’s educational level and knowledge of family communication were significantly associated with its practice among respondents. More studies are  required to evaluate the determinants of the practice of family communication

Awareness, perception and acceptance of malaria vaccine among women of the reproductive age group in a rural community in Soba, Kaduna State, North-west Nigeria.

Malaria vaccine is one of the novel strategies currently being evaluated for use in malaria control in children under five. Objectives: The study aimed to determine the awareness, perception and acceptance of malaria vaccine among women of the reproductive age group in a rural community in Soba Local Government Area of Kaduna State, North-West Nigeria. Methodology: It was a cross-sectional study and total population sampling was used to recruit 236 women aged between 15-49 years. The data were collected using an open data kit (ODK-1) mounted on android tablets and entered into International Business Machine Statistical Package for Social Sciences (IBM SPSS) version 23 Software. Binary logistic regression was used to examine the relationship between the predictor and the outcome variables. Ap-value of less than or equal to 0.05 was considered statistically significant. Results: Only 131 (56%) of the subjects ever heard about malaria vaccines. Of these, 95 (72.5%) knew that the vaccine could prevent malaria and 104 (96.8%) believe that the vaccine was necessary for the prevention of malaria. Further, 89 (67.9%) subjects among those aware of the vaccine would voluntarily allow their children to get vaccinated and 93 (71%), would recommend the vaccines for others. Similarly, 98 (74.8%) of those aware of the vaccine would recommend the vaccine for the National Program on Immunisation. Conclusion: The awareness of the malaria vaccine in the subjects was low while the perception and acceptability of the vaccine were high. None of the risk factors investigated was independently related to awareness of the vaccine. Public enlightenment and further qualitative studies to explore a context-specific perception of the malaria vaccines are recommended

Assessing Research Engagement of Resident Doctors in Training in Northwestern Nigeria

Background: Residency training develops trainees to practice evidence-based medicine using knowledge acquired through researches. Resident doctors are not just expected to be consumers of good researches but are also expected to build their competencies in conducting researches in their fields of specialization. They are expected to engage in journal clubs as well as scientific paper presentations in local and international conferences under the mentorship and guidance of their trainers. In addition, trainers in residency training supervise the compulsory dissertation of senior residents under them. Objectives: We aimed to assess research engagement of resident doctors in training and pattern of submission and approval of their dissertation proposal. Methodology: It was a descriptive cross-sectional descriptive study involving resident doctors in accredited hospitals in Northwestern Nigeria. Electronic questionnaires were distributed to respondents via their verified electronic media contacts. Data were collected within a period of 1 month from July 10 to August 6, 2020. Data were analyzed using mean, standard deviation, simple tables as well as Z‐test and Chi‐square test. The level of significance was set at 0.05 for decision purposes. Results: A total of 120 questionnaires were completed. The mean age of respondents was 38.0 ± 3.8 years, with majority being males 88 (83.3%), and 107 (89.2%) being married. Only 12 (10%) and 44 (36.7%) respondents had published manuscript before and since commencement of residency training, respectively. There was a significant difference between manuscript publication before and since commencement of residency training (P = 0.012). Only 32% of the respondents who submitted their dissertation proposal to the colleges did so within 12 months of success in their Part 1 fellowship examination. There was no association between the publication of manuscript during residency training and submission of dissertation to either National Postgraduate Medical College of Nigeria (P = 0.190), West African College of Surgeons (P = 0.686), or West African College of Physicians (P = 0.317). Conclusion: Research engagement by resident doctors from this study was not satisfactory. Publication of manuscript by resident doctors was associated with prior publication before commencement of residency training and type of training hospital

Assessing Performance of Resident Doctors in Training in Northwestern Nigeria

Background: Residency training is a postgraduate medical education where graduate doctors are mentored toward becoming   independent specialists. In Nigeria currently, the Medical Residency Training Act (MRTA) 2017 guides residency training under the regulation of three postgraduate medical colleges: the National Postgraduate Medical College of Nigeria (NPMCN), West African College of Surgeons (WACS), and West African College of Physicians (WACP). For the respective colleges, resident doctors are expected to attempt Part One and Part Two fellowship examinations after completing their junior and senior residency training, respectively, within stipulated durations. Objectives: The aim of this study is to assess resident doctors’ performance in training and predictive factors. Methodology: Electronic  questionnaires was distributed to respondents through their contacts or emails. Data was collected within a period of one month, from July 10 to August 6, 2020. Data was analyzed using mean, standard deviation, simple tables as well as t‑test and Chi‑square test. The level of significance was set at 0.05 for decision purposes. Results: A total of 120 participants were involved in the study. The mean age of respondents was 38.0 ± 3.8 years, with a majority of 88 (83.3%) males and 107 (89.2%) married. On the first attempt, 48 (65.8%), 37 (60.6%), and 15 (57.7%) respondents were successful in NPMCN, WACS, and WACP Part One fellowship  examinations, respectively. There was no significant difference in the success in Part One between the three postgraduate medical  colleges. There was significant difference in the duration between the first attempt and success in Part One examinations for the three colleges, respectively (NPMCN – P = 0.001, WACS – P < 0.001, WACP – P = 0.036). Conclusion: There was a comparable success in Part One fellowship examination between the three postgraduate medical colleges, with over half of respondents recording success in their first attempt. However, there were significant delays between the first attempt and  success in Part One examination for the three postgraduate medical colleges. Keywords: Part One examination, performance, residency trainin

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

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

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

Background: Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. Methods: 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. Findings: Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. Interpretation: Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic

Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings: Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions

Prevalence, patterns and correlates of smokeless tobacco use in Nigerian adults: An analysis of the Global Adult Tobacco Survey.

IntroductionThe global tobacco epidemic contributes to more than 8 million deaths annually. However, most tobacco control interventions have been driven by an emphasis on smoked tobacco. Globally and more so in Nigeria, less attention has been paid to the similarly harmful smokeless tobacco (SLT) whose use appeals to a different demography. We examined the prevalence, patterns of use and correlates of SLT in Nigerian adults to guide targeted control efforts.MethodsWe conducted a secondary analysis of the 2012 Global Adult Tobacco Survey (GATS) data. We obtained data on 9,765 non-institutionalised adults aged 15 years and older. Variables included current SLT use, sociodemographic characteristics and perceived harm of SLT use. We used Chi-square test to examine associations and binary logistic regression to assess predictors of current SLT use. All analyses were conducted with sample-weighted data.ResultsThe prevalence of current SLT use was 1.9% of all adults. About 1.4% were daily users. The main types were snuff by nose (1.6%) and snuff by mouth (0.8%). There were higher odds of current SLT use for those in the South-East region (aOR = 13.99; 95% CI: 4.45-43.95), rural area residents (aOR = 1.56; 95% CI: 1.04-2.35), males (aOR = 4.43; 95% CI: 2.75-7.11), the 45-64 years age-group (aOR = 10.00; 95% CI: 4.12-24.29), those with no formal education (aOR = 2.67; 95% CI: 1.01-7.05), and those with no perception of harm from SLT use (aOR = 3.81, 95% CI: 2.61-5.56).ConclusionThe prevalence of SLT use among Nigerian adults was low with clearly identified predictors. While a majority were aware of harm from SLT use, an unacceptably high proportion remain unaware. We recommended targeted interventions to increase awareness of the harmful effects of SLT use especially among residents of the South-East, those in rural areas, males, and individuals with no formal education. We also recommended a follow-up survey

Prevalence and factors associated with neonatal sepsis in a tertiary hospital, north west Nigeria

Context: Neonatal sepsis is an important cause of morbidity and mortality of newborns, especially in developing countries. Aims: Our study determined the prevalence of neonatal sepsis and its predisposing factors among neonates admitted in Ahmadu Bello University Teaching Hospital (ABUTH). Settings and Design: This was a cross‑sectional descriptive study conducted in ABUTH. Subjects and Methods: The data were abstracted from the case notes of neonates admitted from May 2017 to May 2018. A pretested pro forma was used to abstract the data. Statistical Analysis Used: Odds ratios and multivariate logistic regression were used to determine the factors associated with neonatal sepsis among the study population. Results: The prevalence of neonatal sepsis was 37.6%. Escherichia coli was the most commonly isolated organism. Neonates 0–7 days of age were 2.8 times less likely to develop neonatal sepsis than older neonates. Babies born with an Apgar score of <6 within the 1st min were 2.4 times more likely to develop neonatal sepsis than those whose Apgar score was higher. Neonates of mothers who had urinary tract infection during pregnancy were 2.3 times more likely to have had sepsis and those whose mothers had premature rupture of membranes were 4.6 times more likely. Conclusions: The prevalence of neonatal sepsis was high among the neonates studied. Neonatal and maternal factors were associated with sepsis in the neonates. These findings provide guidelines for the selection of empirical antimicrobial agents in the study site and suggest that a continued periodic evaluation is needed to anticipate the development of neonatal sepsis among neonates admitted