Exploring the regulatory context for HIV self-testing and PrEP market authorisation and use in Nigeria

Funded by the World Health Organization, this study aimed to assess HIVST/PrEP availability and market authorisation; determine the facilitators and barriers to access; and identify existing systems that support the availability, appropriate use, affordability, and accessibility in the private sector in Nigeria

Estimating morbidity due to stroke in Nigeria: a systematic review and meta-analysis

The response to stroke in Nigeria is impaired by inadequate epidemiologic information. We sought to collate available evidence and estimate the incidence of stroke and prevalence of stroke survivors in Nigeria. Using random effects meta-analysis, we pooled nationwide and regional incidence and prevalence of stroke from the estimates reported in each study. Eleven studies met our selection criteria. The pooled crude incidence of stroke in Nigeria was 26.0 (12.8-39.0) /100,000 person-years, with this higher among men at 34.1 (9.7-58.4) /100,000, compared to women at 21.2 (7.4-35.0) /100,000. The pooled crude prevalence of stroke survivors in Nigeria was 6.7 (5.8-7.7) /1000 population, with this also higher among men at 6.4 (5.1-7.6) /1000, compared to women at 4.4 (3.4-5.5) /1000. In the period 2000-2009, the incidence of stroke in Nigeria was 24.3 (95% CI: 11.9-36.8) per 100,000, with this increasing to 27.4 (95% CI: 2.2-52.7) per 100,000 from 2010 upwards. The prevalence of stroke survivors increased minimally from 6.0 (95% CI: 4.6-7.5) per 1000 to 7.5 (95% CI: 5.8-9.1) per 1000 over the same period. The prevalence of stroke survivors was highest in the South-south region at 13.4 (9.1-17.8) /100,000 and among rural dwellers at 10.8 (7.5-14.1) /100,000. Although study period does not appear to contribute substantially to variations in stroke morbidity in Nigeria, an increasing number of new cases compared to survivors may be due in part to limited door-door surveys, or possibly reflects an increasing mortality from stroke in the country. [Abstract copyright: Copyright © 2019 Elsevier B.V. All rights reserved.

Current prevalence pattern of tobacco smoking in Nigeria: a systematic review and meta-analysis

Background National smoking cessation strategies in Nigeria are hindered by lack of up-to-date epidemiologic data. We aimed to estimate prevalence of tobacco smoking in Nigeria to guide relevant interventions. Methods We conducted systematic search of publicly available evidence from 1990 through 2018. A random-effects meta-analysis and meta-regression epidemiologic model were employed to determine prevalence and number of smokers in Nigeria in 1995 and 2015. Results Across 64 studies (n = 54,755), the pooled crude prevalence of current smokers in Nigeria was 10.4% (9.0–11.7) and 17.7% (15.2–20.2) for ever smokers. This was higher among men compared to women in both groups. There was considerable variation across geopolitical zones, ranging from 5.4% (North-west) to 32.1% (North-east) for current smokers, and 10.5% (South-east) to 43.6% (North-east) for ever smokers. Urban and rural dwellers had relatively similar rates of current smokers (10.7 and 9.1%), and ever smokers (18.1 and 17.0%). Estimated median age at initiation of smoking was 16.8 years (IQR: 13.5–18.0). From 1995 to 2015, we estimated an increase in number of current smokers from 8 to 11 million (or a decline from 13 to 10.6% of the population). The pooled mean cigarettes consumption per person per day was 10.1 (6.1–14.2), accounting for 110 million cigarettes per day and over 40 billion cigarettes consumed in Nigeria in 2015. Conclusions While the prevalence of smokers may be declining in Nigeria, one out of ten Nigerians still smokes daily. There is need for comprehensive measures and strict anti-tobacco laws targeting tobacco production and marketing

An Evaluation of the Integrated Disease Surveillance and Response (IDSR) in Enugu State, Nigeria

Background: The Integrated Disease Surveillance and Response (IDSR), adopted in 1988 at the 48th World Health Organization Regional Committee for Africa meeting in Harare, Zimbabwe, is a regional strategy to strengthen the weak national surveillance systems in the region. In Nigeria, and prior 1988, there was no coordinated system of disease reporting and surveillance system in place until after a major yellow fever outbreak in 1986/87 that claimed many lives. The IDSR in Enugu state, as supported by the WHO, has 17 disease surveillance and notification officers across the 17 LGAs and 89 reporting sites covering the 3000 health facilities. Method: This study is a prospective cross-sectional study using WHO and CDC assessment protocols modified to reflect the local settings. The study samples were selected based on the IDSR performance indicators for AFP, measles core indicators, status of epidemic-prone diseases, and adequacy of feedback and feedforward of surveillance activities. Using desk review of the EPI/IDSR surveillance reports between 2012 and 2017, and also questionnaires between April and July 2017 to eligible participants, data were obtained, cleaned, and analysed using the SPSS version 24. Results: The Overall average score of IDSR performance indicator for Enugu state from the pooled data was 39% against the expected of >80%. These findings are in disagreement with the globally recommended standard IDSR practice and response. Conclusion: The outcome of this study highlights that Enugu state surveillance and IDSR practice are short of the standard practice as prescribed by WHO and CDC assessment protocols. Main reasons for this include poor disease reporting, poor documentation of conducted activities, and lack of adequate feedback system. Similarly, there is non-involvement of community and private health facilities that made up more than 95% of surveillance networks in the state. However, global polio eradication initiative and change management approaches identified remain a huge opportunity for the improvement of the system. Keywords: Enugu State, IDSR, AFP, Measles, Outbreaks, Yellow Fever, Nigeria, WHO, CDC.

Assessing the Knowledge, Practice and Attitudes (KPA) of Traditional Healers in Malaria Control Programme in Nsukka Zone of Enugu State Nigeria

Background: Malaria remains one of the major public health problems as well as the main cause of mortality among young children in sub Saharan Africa and Nigeria in particular. It is endemic throughout Nigeria with about 97% of the population at risk and an estimated 300,000 deaths annually. Malaria is responsible for 60% of outpatient visits and 30% of hospitalizations in children under five years old and contributes to about 11% of maternal mortality in Nigeria. Traditional Healers play an important role in providing health care in Nigeria with a significant proportion of the population patronizing them for treatment of most of their ailments. The aim of this study was to assess the Knowledge, Practice and Attitudes (KPA) of Traditional Healers in malaria control in Enugu state, Nigeria with a view to developing appropriate intervention strategies aimed at improving collaboration and malaria quality of care in rural community settings. Design: This is a qualitative study using ethnographic approach carried out in Nsukka district, a rural community in Enugu North senatorial districts in South-east Nigeria, The study involved in-depth interviews of fifty (50) traditional healers selected out of 68 registered traditional healers in the zone. This was complemented by observations of service delivery to determine the quality of care each traditional healer gave to their patients. The fifty (50) selected partici

Estimating the prevalence of overweight and obesity in Nigeria in 2020: a systematic review and meta-analysis

Background Targeted public health response to obesity in Nigeria is relatively low due to limited epidemiologic understanding. We aimed to estimate nationwide and sub-national prevalence of overweight and obesity in the adult Nigerian population. Methods MEDLINE, EMBASE, Global Health, and Africa Journals Online were systematically searched for relevant epidemiologic studies in Nigeria published on or after 01 January 1990. We assessed quality of studies and conducted a random-effects meta-analysis on extracted crude prevalence rates. Using a meta-regression model, we estimated the number of overweight and obese persons in Nigeria in the year 2020. Results From 35 studies (n = 52,816), the pooled crude prevalence rates of overweight and obesity in Nigeria were 25.0% (95% confidence interval, CI: 20.4–29.6) and 14.3% (95% CI: 12.0–15.5), respectively. The prevalence in women was higher compared to men at 25.5% (95% CI: 17.1–34.0) versus 25.2% (95% CI: 18.0–32.4) for overweight, and 19.8% (95% CI: 3.9–25.6) versus 12.9% (95% CI: 9.1–16.7) for obesity, respectively. The pooled mean body mass index (BMI) and waist circumference were 25.6 kg/m2 and 86.5 cm, respectively. We estimated that there were 21 million and 12 million overweight and obese persons in the Nigerian population aged 15 years or more in 2020, accounting for an age-adjusted prevalence of 20.3% and 11.6%, respectively. The prevalence rates of overweight and obesity were consistently higher among urban dwellers (27.2% and 14.4%) compared to rural dwellers (16.4% and 12.1%). Conclusions Our findings suggest a high prevalence of overweight and obesity in Nigeria. This is marked in urban Nigeria and among women, which may in part be due to widespread sedentary lifestyles and a surge in processed food outlets, largely reflective of a trend across many African settings

Expanding antiretroviral therapy in Malawi: drawing on the country's experience with tuberculosis

The DOTS (“directly observed treatment, short course”) strategy has been successfully used in developing countries to provide effective control of tuberculosis. Field workers in Malawi are promoting the same approach for HIV infection through the expansion of highly active antiretroviral therap

Monitoring the response to antiretroviral therapy in resource-poor settings: the Malawi model.

With assistance from the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), Malawi is scaling-up the delivery of antiretroviral (ARV) therapy to HIV-positive eligible patients. The country has developed National ARV Treatment Guidelines, which emphasize a structured and standardized approach for all aspects of ARV delivery, including monitoring and evaluation. Using the successful DOTS model adapted by National TB Control Programmes throughout the world, Malawi has developed a system of quarterly ARV cohort and cumulative ARV quarterly analyses. Thyolo district, in the southern region of Malawi, has been using this system since April 2003. This paper describes the standardized ARV treatment regimens and the treatment outcomes used in Thyolo to assess the impact of treatment, the registration and monitoring systems and how the cohort analyses are carried out. Data are presented for case registration and treatment outcome for the first quarterly cohort (April to June) and the combined cohorts (April to June and July to September). Such quarterly analyses may be useful for districts and Ministries of Health in assessing ARV delivery, although the burden of work involved in calculating the numbers may become large once ARV delivery systems have been established for several years

High Prevalence of HIV Drug Resistance Among Newly Diagnosed Infants Aged <18 Months: Results From a Nationwide Surveillance in Nigeria

BACKGROUND: WHO recommends protease-inhibitor-based first-line regimen in infants because of risk of drug resistance from failed prophylaxis used in prevention of mother-to-child transmission (PMTCT). However, cost and logistics impede implementation in sub-Saharan Africa, and >75% of children still receive nonnucleoside reverse transcriptase inhibitor-based regimen (NNRTI) used in PMTCT. METHODS: We assessed the national pretreatment drug resistance prevalence of HIV-infected children aged <18 months in Nigeria, using WHO-recommended HIV drug resistance surveillance protocol. We used remnant dried blood spots collected between June 2014 and July 2015 from 15 early infant diagnosis facilities spread across all the 6 geopolitical regions of Nigeria. Sampling was through a probability proportional-to-size approach. HIV drug resistance was determined by population-based sequencing. RESULTS: Overall, in 48% of infants (205 of 430) drug resistance mutations (DRM) were detected, conferring resistance to predominantly NNRTIs (45%). NRTI and multiclass NRTI/NNRTI resistance were present at 22% and 20%, respectively, while resistance to protease inhibitors was at 2%. Among 204 infants with exposure to drugs for PMTCT, 57% had DRMs, conferring NNRTI resistance in 54% and multiclass NRTI/NNRTI resistance in 29%. DRMs were also detected in 34% of 132 PMTCT unexposed infants. CONCLUSION: A high frequency of PDR, mainly NNRTI-associated, was observed in a nationwide surveillance among newly diagnosed HIV-infected children in Nigeria. PDR prevalence was equally high in PMTCT-unexposed infants. Our results support the use of protease inhibitor-based first-line regimens in HIV-infected young children regardless of PMTCT history and underscore the need to accelerate implementation of the newly disseminated guideline in Nigeria