Descriptive characterization of the cerebrospinal meningitis outbreak in Zamfara State, 2017-18

Introduction: Cerebro-spinal meningitis (CSM) is an epidemic-prone disease characterized by inflammation of the meninges. From epidemiological week 36, 2017 through epidemiological week 21, 2018, Zamfara State reported an outbreak of CSM that affected all the 14 Local Government Areas (LGAs). Therefore, we conducted a descriptive analysis of the outbreak to determine its epidemiology. Methods: We line-listed all suspected cases during the outbreak between September 4th 2017, and May 22nd 2018. We described the outbreak in time, place and person and calculated the attack rates by LGA and the age- and sex-specific case fatality rates (CFR). Results: A total of 1125 cases were reported with an overall attack rate and CFR of 25.2 cases/100,000 population and 7.6%, respectively. The age-specific CFR was highest among individuals aged 5-9 years (9.7%), while the sex-specific CFR was almost equal in males and females. The epidemiologic curve showed an increasing number of weekly reported cases with several peaks, the highest in week 12, 2018. A clustering of cases was seen in 2 contiguous LGAs, Bungudu and Gusau; while the highest attack rate was recorded in Shinkafi LGA (51 cases/100,000 population). Only 24% of suspected cases had their cerebrospinal fluid collected, and Neisseria meningitidis C accounted for 77.1% of causative agents. Conclusion: Zamfara State has experienced an outbreak of CSM. Training health workers and improving their skills on sample collection and treatment protocol will improve profiling of causative agents and outcomes. The use of Vaccines containing serogroup C will help to prevent future outbreaks

Assessment of Orange (Citrus Sinensis) Supply Chain Activities in Kano State

The study focused on the handling system of orange in Yanlemo Market of Kano State. A field study was conducted with structural questionnaires that targeted the orange supplies, traders and agricultural equipment suppliers/fabricators. Result obtained reveals that the orange handling activity is dominated by male traders. Average of 2 to 5 bags of oranges are usually handled by about 53.3% of the respondents, while 8.3% handle more than 10 bags of the oranges daily. Dan Tivi was found to be the commonest orange variety in the study area. Some other varieties established in the study area are; Dan Nassarawa, Dan Ondo and Dan Delta representing about 8.3, 1.7 and 1.7% of the varieties handled in the study area respectively. The mode of transportation, sorting, and washing was found to be manual with a lot of challenges. The predominant manual handling of the orange established in the study area could be amongst the major reasons for the high losses usually recorded by the traders on a daily basis. Thus, useful suggestions that could be employed by researchers and policymakers to provide improvements in the supply chain activities to prevent such losses are presented.  Keywords— Orange, Assessment, Supply Chain, Handlin

Improving maternal and newborn health services in Northeast Nigeria through a government-led partnership of stakeholders: a quasi-experimental study.

OBJECTIVES: This study aimed to quantify change in the coverage, quality and equity of essential maternal and newborn healthcare interventions in Gombe state, Northeast Nigeria, following a four year, government-led, maternal and newborn health intervention. DESIGN: Quasi-experimental plausibility study. Repeat cross-sectional household and linked health facility surveys were implemented in intervention and comparison areas. SETTING: Gombe state, Northeast Nigeria. PARTICIPANTS: Each household survey included a sample of 1000 women aged 13-49 years with a live birth in the previous 12 months. Health facility surveys comprised a readiness assessment and birth attendant interview. INTERVENTIONS: Between 2016-2019 a complex package of evidence-based interventions was implemented to increase access, use and quality of maternal and newborn healthcare, spanning the six WHO health system building blocks. OUTCOME MEASURES: Eighteen indicators of maternal and newborn healthcare. RESULTS: Between 2016 and 2019, the coverage of all indicators improved in intervention areas, with the exception of postnatal and postpartum contacts, which remained below 15%. Greater improvements were observed in intervention than comparison areas for eight indicators, including coverage of at least one antenatal visit (71% (95% CI 62 to 68) to 88% (95% CI 82 to 93)), at least four antenatal visits (46% (95% CI 39 to 53) to 69% (95% CI 60 to 75)), facility birth (48% (95% CI 37 to 59) to 64% (95% CI 54 to 73)), administration of uterotonics (44% (95% CI 34 to 54) to 59% (95% CI 50 to 67)), delayed newborn bathing (44% (95% CI 36 to 52) to 62% (95% CI 52 to 71)) and clean cord care (42% (95% CI 34 to 49) to 73% (95% CI 66 to 79)). Wide-spread inequities persisted however; only at least one antenatal visit saw pro-poor improvement. CONCLUSIONS: This intervention achieved improvements in life-saving behaviours for mothers and newborns, demonstrating that multipartner action, coordinated through government leadership, can shift the needle in the right direction, even in resource-constrained settings

Meningococcus serogroup C clonal complex ST-10217 outbreak in Zamfara State, Northern Nigeria.

After the successful roll out of MenAfriVac, Nigeria has experienced sequential meningitis outbreaks attributed to meningococcus serogroup C (NmC). Zamfara State in North-western Nigeria recently was at the epicentre of the largest NmC outbreak in the 21st Century with 7,140 suspected meningitis cases and 553 deaths reported between December 2016 and May 2017. The overall attack rate was 155 per 100,000 population and children 5-14 years accounted for 47% (3,369/7,140) of suspected cases. The case fatality rate (CFR) among children 5-9 years was 10%, double that reported among adults ≥ 30 years (5%). NmC and pneumococcus accounted for 94% (172/184) and 5% (9/184) of the laboratory-confirmed cases, respectively. The sequenced NmC belonged to the ST-10217 clonal complex (CC). All serotyped pneumococci were PCV10 serotypes. The emergence of NmC ST-10217 CC outbreaks threatens the public health gains made by MenAfriVac, which calls for an urgent strategic action against meningitis outbreaks

Burden and Trend of Measles in Nigeria: Five-year Review Case-base Surveillance Data

ObjectiveWe reviewed measles specific Integretaged Disease Surveillance and Response (IDSR) data from Nigeria over a five-year period to highlights its burden and trends, and make recommendations for improvements.IntroductionMeasles is a vaccine preventable, highly transmissible viral infection that affects mostly under-five year children. The disease is caused by a Morbillivirus; member of the Paramyxovirus family.MethodsWe conducted a secondary data analysis of measles specific IDSR records of all States in Nigeria from January 2012 to September 2016. The record had reported measles cases with laboratory outcomes from all the States. IDSR weekly epidemiological data were obtained from Surveillance Unit, Nigerian Centre for Disease Control (NCDC).ResultsA total of 131,732 cases were recorded within the period. Highest number of cases 57,892(43.95%) were recorded in 2013 while the least number of cases 11,061(8.4%) were recorded in 2012. A total of 817 deaths were recorded, given a case fatality rate (CFR) of 0.62%. The CFR showed a decreasing trend over the years with the highest CFR (1.43%) recorded in 2012 and the least CFR (0.44%) recorded in 2016. Only 8,916 (6.7%) cases were confirmed by laboratory investigation. The Northwest region recorded the highest attack rate (AR) of 149.7 cases per 100,000 population, followed by the Northeast region with 140.2 cases per 100,000 population, while the South-south region recorded the least AR of 15.8 cases per 100,000 population. Case Fatality Rate per region followed similar pattern, with the Northcentral region having the highest CFR of 4.38%. The trend of measles cases followed the same pattern. Cases peaked at March, then gradually reduced to lowest level at June.ConclusionsMeasles infection remains a burden especially in the northern region of Nigeria. Though measles fatalities were on decline over the years, laboratory diagnosis of cases has been suboptimal. We recommended improvement on routine immunization and measles case management, and strengthening of regional laboratories capacity for measles diagnosis.References1. WHO | Measles. WHO [Internet]. World Health Organization; 2017 [cited 2017 Apr 10]; Available from: http://www.who.int/mediacentre/factsheets/fs286/en/2. Akande TM. A review of measles vaccine failure in developing countries. Niger. Med. Pract. SAME Ventures; 2007;52:112–6.3. Ibrahim BS, Gana GJ, Mohammed Y, Bajoga UA, Olufemi AA, Umar AS, et al. Outbreak of measles in Sokoto State North-Western Nigeria, three months after a supplementary immunization campaign: An investigation report 2016. Australas. Med. J. AUSTRALASIAN MEDICAL JOURNAL PTY LTD HILLARYS, GPO BOX 367, PERTH, WA 6923, AUSTRALIA; 2016;9:324–35.

Predictors of malaria Rapid Diagnostic Tests' utilisation among healthcare workers in Zamfara State.

INTRODUCTION:Early diagnosis and prompt and effective treatment is one of the pillars of malaria control. Malaria case management guidelines recommend diagnostic testing before treatment using malaria Rapid Diagnostic Test (mRDT) or microscopy and this was adopted in Nigeria in 2010. However, despite the deployment of mRDT, the use of mRDTs by health workers varies by settings. This study set out to assess factors influencing utilisation of mRDT among healthcare workers in Zamfara State, Nigeria. METHODS:A cross-sectional study was carried out among 306 healthcare workers selected using multistage sampling from six Local Government Areas between January and February 2017. Mixed method was used for data collection. A pre-tested self-administered questionnaire was used to collect information on knowledge, use of mRDT and factors influencing utilization. An observational checklist was used to assess the availability of mRDT in the six months prior to this study. Data were analyzed using descriptive statistics such as means and proportions. Association between mRDT use and independent variables was tested using Chi square while multiple regression was used to determine predictors of use at 5% level of significance. RESULTS:Mean age of respondents was 36.0 ± 9.4years. Overall, 198 (64.7%) of health workers had good knowledge of mRDT; mRDT was available in 33 (61.1%) facilities. Routine use of mRDT was reported by 253 (82.7%) healthcare workers. This comprised 89 (35.2%) laboratory scientists/technicians, 89 (35.2%) community health extension workers/community health officers; 59 (23.3%) nurses and 16 (6.3%) doctors. Health workers' good knowledge of mRDT, trust in mRDT results, having received prior training on mRDT, and non-payment for mRDT were predictors of mRDT utilisation. CONCLUSION:This study demonstrated that healthcare worker utilisation of mRDT was associated with health worker and health system-related factors that are potentially modifiable. There is need to sustain training of healthcare workers on benefits of using mRDT and provision of free mRDT in health facilities

Predictors of Malaria Rapid Diagnostic Tests' Utilisation Among Healthcare Workers in Zamfara State.

Introduction: Early diagnosis and prompt and effective treatment is one of the pillars of malaria control Malaria case management guidelines recommend diagnostic testing before treatment using malaria Rapid Diagnostic Test (mRDT) or microscopy and this was adopted in Nigeria in 2010. However, despite the deployment of mRDT, the use of mRDTs by health workers varies by settings. This study set out to assess factors influencing utilisation of mRDT among healthcare workers in Zamfara State, Nigeria. Methods: A cross-sectional study was carried out among 306 healthcare workers selected using multistage sampling from six Local Government Areas between January and February 2017. Mixed method was used for data collection. A pre-tested self-administered questionnaire was used to collect information on knowledge, use of mRDT and factors influencing utilization. An observational checklist was used to assess the availability of mRDT in the six months prior to this study. Data were analyzed using descriptive statistics such as means and proportions. Association between mRDT use and independent variables was tested using Chi square while multiple regression was used to determine predictors of use at 5% level of significance. Results: Mean age of respondents was 36.0 ± 9.4years. Overall, 198 (64.7%) of health workers had good knowledge of mRDT; mRDT was available in 33 (61.1%) facilities. Routine use of mRDT was reported by 253 (82.7%) healthcare workers. This comprised 89 (35.2%) laboratory scientists/technicians, 89 (35.2%) community health extension workers/community health officers; 59 (23.3%) nurses and 16 (6.3%) doctors. Health workers’ good knowledge of mRDT, trust in mRDT results, having received prior training on mRDT, and non-payment for mRDT were predictors of mRDT utilisation. Conclusion: This study demonstrated that healthcare worker utilisation of mRDT was associated with health worker and health system-related factors that are potentially modifiable. There is need to sustain training of healthcare workers on benefits of using mRDT and provision of free mRDT in health facilities

Health workers' perception of malaria rapid diagnostic test and factors influencing compliance with test results in Ebonyi state, Nigeria.

BackgroundThe standard practice in treating uncomplicated malaria is to prescribe artemisinin-based combination therapy (ACT) for only patients with positive test results. However, health workers (HWs) sometimes prescribe ACTs for patients with negative malaria rapid diagnostic test (mRDT) results. Available evidence on HWs perception of mRDT and their level of compliance with test results in Nigeria lacks adequate stratification by state and context. We assessed HWs perception of mRDT and factors influencing ACTs prescription to patients with negative mRDT results in Ebonyi state, Nigeria.MethodsA cross-sectional survey was conducted among 303 HWs who treat suspected malaria patients in 40 randomly selected public and private health facilities in Ebonyi state. Health workers' perception of mRDT was assessed with 18 equally weighted five-point likert scale questions with maximum obtainable total score of 90. Scores ≥72 were graded as good and less, as poor perception. Data were analysed using descriptive statistics and logistic regression model at 5% significance level.ResultsMean age of respondents was 34.6±9.4 years, 229 (75.6%) were females, 180 (59.4%) community health workers and 67 (22.1%) medical doctors. Overall, 114 (37.6%) respondents across healthcare facility strata had poor perception of mRDT. Respondents who prescribed ACTs to patients with negative mRDT results within six months preceding the survey were 154 (50.8%) [PHCs: 50 (42.4%), General hospitals: 18 (47.4%), tertiary facility: 51 (79.7%) and missionary hospitals: 35 (42.2%)]. Poor HWs' perception of mRDT promoted prescription of ACT to patients with negative mRDT results (AOR = 5.6, 95% C.I = 3.2-9.9). The likelihood of prescribing ACTs to patients with negative mRDT results was higher among HWs in public health facilities (AOR = 2.8, 95% C.I = 1.4-5.5) than those in the private.ConclusionsThe poor perception of mRDT and especially common prescribing of ACTs to patients with negative mRDT results among HWs in Ebonyi state calls for context specific interventions to improve their perception and compliance with mRDT test results

Knowledge, risk perception and uptake of COVID-19 vaccination among internally displaced persons in complex humanitarian emergency setting, Northeast Nigeria

Abstract Background Owing to crowded and unsanitary conditions, internally displaced persons (IDPs) have an increased risk of COVID-19 infection. Adoption of COVID-19 preventive measures among this population is premised on accurate information, adequate knowledge, and risk perception. We assessed COVID-19 knowledge and risk perception and investigated the association between risk perception and COVID-19 preventive measures, including vaccination among IDPs in Northeast Nigeria. Methods We conducted a cross-sectional study during July–December 2022 and sampled 2,175 IDPs using stratified sampling. We utilized a 12-point assessment tool to evaluate COVID-19 knowledge. Participants who scored ≥ 6 points were considered to have adequate knowledge. We used a 30-item Risk Behavior Diagnosis Scale to assess COVID-19 risk perception and evaluated each item on a 5-point Likert scale. Participants were divided into risk perception categories by the median of Likert scale scores. We performed weighted logistic regression analysis to identify factors associated with risk perception. Pearson’s chi-squared with Rao-Scott adjustment was used to determine the relationship between risk perception and COVID-19 preventive measures. Results Of 2,175 participants, 55.7% were 18–39 years old, 70.9% were females, and 81.7% had no formal education. Among the IDPs, 32.0% (95% CI: 28.8 – 35.0) were considered to have adequate COVID-19 knowledge, and 51.3% (95% CI: 47.8 – 54.8) perceived COVID-19 risk as high. Moreover, 46.3% (95% CI: 42.8 – 50.0) had received one dose of COVID-19 vaccine, and 33.1% (95% CI: 29.8 – 36.0) received two doses. Adequate knowledge (Adjusted Odds Ratio (AOR) = 2.10, [95% CI: 1.46 – 3.03]) and post-primary education (AOR = 3.20, [95% CI: 1.59 – 6.46]) were associated with risk perception. Furthermore, high risk perception was significantly associated with wearing face masks (χ2 = 106.32, p-value < .001), practicing hand hygiene (χ2 = 162.24, p-value < .001), physical distancing (χ2 = 60.84, p-value < .001) and vaccination uptake (χ2 = 46.85, p-value < .001). Conclusions This study revealed gaps in COVID-19 knowledge, risk perception, and vaccination uptake but demonstrated a significant relationship between risk perception and COVID-19 preventive practices. Health education and risk communication should be intensified to improve knowledge, elicit stronger risk perception, and enhance COVID-19 preventive practices

Additional file 1 of Knowledge, risk perception and uptake of COVID-19 vaccination among internally displaced persons in complex humanitarian emergency setting, Northeast Nigeria

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