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

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

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%.

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

National health insurance scheme: how protected are households in Oyo State, Nigeria from catastrophic health expenditure?

Background: The major objective of the National Health Insurance Scheme (NHIS) in Nigeria is to protect families from the financial hardship of large medical bills. Catastrophic Health Expenditure (CHE) is rampart in Nigeria despite the take-off of the NHIS. This study aimed to determine if households enrolled in the NHIS were protected from having CHE. Methods: The study took place among 714 households in urban communities of Oyo State. CHE was measured using a threshold of 40% of monthly non-food expenditure. Descriptive statistics were done, Principal Component Analysis was used to divide households into wealth quintiles. Chi-square test and binary logistic regression were done. Results: The mean age of household respondent was 33.5 years. The median household income was 43,500 naira (290 US dollars) and the range was 7,000–680,000 naira (46.7–4,533 US dollars) in 2012. The overall median household healthcare cost was 890 naira (5.9 US dollars) and the range was 10-17,700 naira (0.1–118 US dollars) in 2012. In all, 67 (9.4%) households were enrolled in NHIS scheme. Healthcare services was utilized by 637 (82.9%) and CHE occurred in 42 (6.6%) households. CHE occurred in 14 (10.9%) of the households in the lowest quintile compared to 3 (2.5%) in the highest wealth quintile ( P = 0.004). The odds of CHE among households in lowest wealth quintile is about 5 times. They had Crude OR (CI): 4.7 (1.3–16.8), P = 0.022. Non enrolled households were two times likely to have CHE, though not significant Conclusion: Households in the lowest wealth quintiles were at higher risk of CHE. Universal coverage of health insurance in Nigeria should be fast-tracked to give the expected financial risk protection and decreased incidence of CHE

COVID-19 in Nigeria: Is the pharmaceutical sector spared?

No abstract available

Willingness to Participate in Testing, Contact Tracing, and Taking the COVID-19 Vaccine among Community Members in a Southwestern State in Nigeria

'Background: 'This study aimed to describe community members’ willingness to participate in COVID-19 testing, contact tracing, and acceptance of the COVID-19 vaccine in a Southwestern state in Nigeria. '''Methods: 'We conducted a descriptive cross-sectional study using an interviewer-administered questionnaire. Community members aged 15 years and above were studied using a multi-stage sampling technique. One question each was asked on respondents’ willingness for COVID-19 testing, contact disclosure, and willingness to take the COVID-19 vaccine. Descriptive statistics and chi-square tests were conducted on willingness for COVID-19 testing, contact disclosure and taking the COVID-19 vaccine. Multivariate logistic analyses were performed on variables that were significant at the bivariate level. P-values <0.05 were statistically significant.'' 'Results: 'Among the 691 respondents, 244 (35.3%) were aged 21-29 years, 436 (73.2%) were willing to take the COVID-19 test, 458 (66.3%) were willing to disclose contacts’ names if tested positive, and 434 (74.8%) were willing to take the COVID-19 vaccine. Persons who earned less than 30,000 naira (U.S.$78.95) monthly had two times the odds to be willing to take the COVID-19 test (OR=2.031, (95%CI=1.117-3.694), p = 0.02). Persons who had completed 10-12 years of education had three times the odds to be willing to disclose contacts if tested positive for COVID-19 (OR=2.628, (95%CI=1.301-5.308), p=0.007). Persons whose financial status worsened, i.e., those whose income had reduced during the COVID-19 pandemic, had three times the odds to be willing to take the COVID-19 vaccine (OR=2.686, (95%CI=1.363-6.448), p=0.006).'' 'Conclusion: 'Interventions to improve willingness for COVID-19 testing and taking the COVID-19 vaccine should be targeted towards those wealthy individuals.'