Knowledge and home treatment of measles infection by caregivers of children under five in a low-income urban community, Nigeria

Background: Despite the availability of a safe and effective vaccine for over 50 years, measles remains a leading cause of death among young children in developing countries. Aim: This study assessed the knowledge and home treatment of measles by caregivers of children under 5 years. Setting: Abebi community, Ibadan, Oyo State, Nigeria. Methods: A descriptive cross-sectional study of 509 caregivers of children aged 6 months to 5 years in a semi-urban community in Ibadan was conducted using a multi-stage sampling method. An interviewer administered structured questionnaire was used to collect information on socio-demographic characteristics, knowledge of aetiology, main symptoms and signs, and home treatment of measles. Chi-square test and logistic regression were used to explore associations at 5% level of significance. Results: Most of the caregivers were females (96.3%), married (86.1%) and were the biological parents of the children (90.9%). More than half had good knowledge of the cause (59.7%) and main symptoms and signs (52.8%) of measles. However, the composite knowledge was good in 57.6% of caregivers. Over half (54.4%) of the caregivers reported that their children ever had measles. Majority (91.3%) of caregivers whose children had measles gave home treatment, while 24 (8.7%) sought treatment from health facilities alone. There was a significant association between caregivers’ educational status, age, tribe and marital status and their knowledge of measles; however, tribe was the only significant predictor of knowledge after regression analysis. Caregivers from other tribes were 3.3 times more likely to have good knowledge of measles than Yoruba caregivers. Caregivers who were 35 years and older compared to those younger than 35 years (OR: 0.625; 95% CI: 0.425–0.921) and those who were not currently married compared to those married (OR: 0.455; 95% CI: 0.273–0.758) had lower odds of having good knowledge of measles, respectively. Conclusion: Home treatment by caregivers of children with measles is high. Health education on the cause, prevention and treatment of measles should be provided for caregivers

Maternal mental well-being and recent child illnesses–A cross-sectional survey analysis from Jigawa State, Nigeria

Child health indicators in Northern Nigeria remain low. The bidirectional association between child health and maternal well-being is also poorly understood. We aim to describe the association between recent child illness, socio-demographic factors and maternal mental well-being in Jigawa State, Nigeria. We analysed a cross-sectional household survey conducted in Kiyawa local government area, Jigawa State, from January 2020 to March 2020 amongst women aged 16–49 with at least one child under-5 years. We used two-stage random sampling. First, we used systematic random sampling of compounds, with the number of compounds based on the size of the community. The second stage used simple random sampling to select one eligible woman per compound. Mental well-being was assessed using the Short Warwick-Edinburgh Mental Wellbeing Score (SWEMWBS). We used linear regression to estimate associations between recent child illness, care-seeking and socio-demographic factors, and mental well-being. Overall 1,661 eligible women were surveyed, and 8.5% had high mental well-being (metric score of 25.0–35.0) and 29.5% had low mental well-being (metric score of 7.0–17.9). Increasing wealth quintile (adj coeff: 1.53; 95% CI: 0.91–2.15) not being a subsistence farmer (highest adj coeff: 3.23; 95% CI: 2.31–4.15) and having a sick child in the last 2-weeks (adj coeff: 1.25; 95% CI: 0.73–1.77) were significantly associated with higher mental well-being. Higher levels of education and increasing woman’s age were significantly associated with lower mental well-being. Findings contradicted our working hypothesis that a recently sick child would be associated with lower mental well-being. We were surprised that education and late marriage, which are commonly attributed to women’s empowerment and autonomy, were not linked to better well-being here. Future work could focus on locally defined tools to measure well-being reflecting the norms and values of communities, ensuring solutions that are culturally acceptable and desirable to women with low mental well-being are initiated

Community perceptions matter: a mixed-methods study using local knowledge to define features of success for a community intervention to improve quality of care for children under-5 in Jigawa, Nigeria

Objectives In this study, we used the information generated by community members during an intervention design process to understand the features needed for a successful community participatory intervention to improve child health. Design We conducted a concurrent mixed-methods study (November 2019–March 2020) to inform the design and evaluation of a community–facility linkage participatory intervention. Setting Kiyawa Local Government Area (Jigawa State, Nigeria)—population of 230 000 (n=425 villages). Participants Qualitative data included 12 community conversations with caregivers of children under-5 (men, older and younger women; n=9 per group), 3 focus group discussions (n=10) with ward development committee members and interviews with facility heads (n=3). Quantitative data comprised household surveys (n=3464) with compound heads (n=1803) and women (n=1661). Results We analysed qualitative data with thematic network analysis and the surveys with linear regression—results were triangulated in the interpretation phase. Participants identified the following areas of focus: community health education; facility infrastructure, equipment and staff improvements; raising funds to make these changes. Community involvement, cooperation and empowerment were recognised as a strategy to improve child health, and the presence of intermediate bodies (development committees) was deemed important to improve communication and solve problems between community and facility members. The survey showed functional community relations’ dynamics, with high levels of internal cohesion (78%), efficacy in solving problems together (79%) and fairness of the local leaders (82%). Conclusions Combining the results from this study and critical theories on successful participation identified community-informed features for a contextually tailored community–facility link intervention. The need to promote a more inclusive approach to future child health interventions was highlighted. In addition to health education campaigns, the relationship between community and healthcare providers needs strengthening, and development committees were identified as an essential feature for successfully linking communities and facilities for child health. Trial registration number ISRCTN39213655

Prevalence of pneumonia and malnutrition among children in Jigawa state, Nigeria: a community-based clinical screening study

Objective: To estimate the point prevalence of pneumonia and malnutrition and explore associations with household socioeconomic factors. / Design: Community-based cross-sectional study conducted in January–June 2021 among a random sample of households across all villages in the study area. / Setting: Kiyawa Local Government Area, Jigawa state, Nigeria. / Participants: Children aged 0–59 months who were permanent residents in Kiyawa and present at home at the time of the survey. / Main outcome measures: Pneumonia (non-severe and severe) defined using WHO criteria (2014 revision) in children aged 0–59 months. Malnutrition (moderate and severe) defined using mid-upper arm circumference in children aged 6–59 months. / Results: 9171 children were assessed, with a mean age of 24.8 months (SD=15.8); 48.7% were girls. Overall pneumonia (severe or non-severe) point prevalence was 1.3% (n=121/9171); 0.6% (n=55/9171) had severe pneumonia. Using an alternate definition that did not rely on caregiver-reported cough/difficult breathing revealed higher pneumonia prevalence (n=258, 2.8%, 0.6% severe, 2.2% non-severe). Access to any toilet facility was associated with lower odds of pneumonia (aOR: 0.56; 95% CI: 0.31 to 1.01). The prevalence of malnutrition (moderate or severe) was 15.6% (n=1239/7954) with 4.1% (n=329/7954) were severely malnourished. Being older (aOR: 0.22; 95% CI: 0.17 to 0.27), male (aOR: 0.77; 95% CI: 0.66 to 0.91) and having head of compound a business owner or professional (vs subsistence farmer, aOR 0.71; 95% CI: 0.56 to 0.90) were associated with lower odds of malnutrition. / Conclusions: In this large, representative community-based survey, there was a considerable pneumonia and malnutrition morbidity burden. We noted challenges in the diagnosis of Integrated Management of Childhood Illness-defined pneumonia in this context

Pulse oximetry and oxygen services for the care of children with pneumonia attending frontline health facilities in Lagos, Nigeria (INSPIRING-Lagos): study protocol for a mixed-methods evaluation.

Introduction The aim of this evaluation is to understand whether introducing stabilisation rooms equipped with pulse oximetry and oxygen systems to frontline health facilities in Ikorodu, Lagos State, alongside healthcare worker (HCW) training improves the quality of care for children with pneumonia aged 0–59 months. We will explore to what extent, how, for whom and in what contexts the intervention works.Methods and analysis Quasi-experimental time-series impact evaluation with embedded mixed-methods process and economic evaluation. Setting: seven government primary care facilities, seven private health facilities, two government secondary care facilities. Target population: children aged 0–59 months with clinically diagnosed pneumonia and/or suspected or confirmed COVID-19. Intervention: ‘stabilisation rooms’ within participating primary care facilities in Ikorodu local government area, designed to allow for short-term oxygen delivery for children with hypoxaemia prior to transfer to hospital, alongside HCW training on integrated management of childhood illness, pulse oximetry and oxygen therapy, immunisation and nutrition. Secondary facilities will also receive training and equipment for oxygen and pulse oximetry to ensure minimum standard of care is available for referred children. Primary outcome: correct management of hypoxaemic pneumonia including administration of oxygen therapy, referral and presentation to hospital. Secondary outcome: 14-day pneumonia case fatality rate. Evaluation period: August 2020 to September 202

Pulse oximetry and oxygen services for the care of children with pneumonia attending frontline health facilities in Lagos, Nigeria (INSPIRING-Lagos): study protocol for a mixed-methods evaluation

INTRODUCTION: The aim of this evaluation is to understand whether introducing stabilisation rooms equipped with pulse oximetry and oxygen systems to frontline health facilities in Ikorodu, Lagos State, alongside healthcare worker (HCW) training improves the quality of care for children with pneumonia aged 0-59 months. We will explore to what extent, how, for whom and in what contexts the intervention works. METHODS AND ANALYSIS: Quasi-experimental time-series impact evaluation with embedded mixed-methods process and economic evaluation. SETTING: seven government primary care facilities, seven private health facilities, two government secondary care facilities. TARGET POPULATION: children aged 0-59 months with clinically diagnosed pneumonia and/or suspected or confirmed COVID-19. INTERVENTION: 'stabilisation rooms' within participating primary care facilities in Ikorodu local government area, designed to allow for short-term oxygen delivery for children with hypoxaemia prior to transfer to hospital, alongside HCW training on integrated management of childhood illness, pulse oximetry and oxygen therapy, immunisation and nutrition. Secondary facilities will also receive training and equipment for oxygen and pulse oximetry to ensure minimum standard of care is available for referred children. PRIMARY OUTCOME: correct management of hypoxaemic pneumonia including administration of oxygen therapy, referral and presentation to hospital. SECONDARY OUTCOME: 14-day pneumonia case fatality rate. Evaluation period: August 2020 to September 2022. ETHICS AND DISSEMINATION: Ethical approval from University of Ibadan, Lagos State and University College London. Ongoing engagement with government and other key stakeholders during the project. Local dissemination events will be held with the State Ministry of Health at the end of the project (December 2022). We will publish the main impact results, process evaluation and economic evaluation results as open-access academic publications in international journals. TRIAL REGISTRATION NUMBER: ACTRN12621001071819; Registered on the Australian and New Zealand Clinical Trials Registry

Integrated Sustainable childhood Pneumonia and Infectious disease Reduction in Nigeria (INSPIRING) through whole system strengthening in Jigawa, Nigeria: study protocol for a cluster randomised controlled trial

BACKGROUND: Child mortality remains unacceptably high, with Northern Nigeria reporting some of the highest rates globally (e.g. 192/1000 live births in Jigawa State). Coverage of key protect and prevent interventions, such as vaccination and clean cooking fuel use, is low. Additionally, knowledge, care-seeking and health system factors are poor. Therefore, a whole systems approach is needed for sustainable reductions in child mortality. METHODS: This is a cluster randomised controlled trial, with integrated process and economic evaluations, conducted from January 2021 to September 2022. The trial will be conducted in Kiyawa Local Government Area, Jigawa State, Nigeria, with an estimated population of 230,000. Clusters are defined as primary government health facility catchment areas (n = 33). The 33 clusters will be randomly allocated (1:1) in a public ceremony, and 32 clusters included in the impact evaluation. The trial will evaluate a locally adapted 'whole systems strengthening' package of three evidence-based methods: community men's and women's groups, Partnership Defined Quality Scorecard and healthcare worker training, mentorship and provision of basic essential equipment and commodities. The primary outcome is mortality of children aged 7 days to 59 months. Mortality will be recorded prospectively using a cohort design, and secondary outcomes measured through baseline and endline cross-sectional surveys. Assuming the following, we will have a minimum detectable effect size of 30%: (a) baseline mortality of 100 per 1000 livebirths, (b) 4480 compounds with 3 eligible children per compound, (c) 80% power, (d) 5% significance, (e) intra-cluster correlation of 0.007 and (f) coefficient of variance of cluster size of 0.74. Analysis will be by intention-to-treat, comparing intervention and control clusters, adjusting for compound and trial clustering. DISCUSSION: This study will provide robust evidence of the effectiveness and cost-effectiveness of community-based participatory learning and action, with integrated health system strengthening and accountability mechanisms, to reduce child mortality. The ethnographic process evaluation will allow for a rich understanding of how the intervention works in this context. However, we encountered a key challenge in calculating the sample size, given the lack of timely and reliable mortality data and the uncertain impacts of the COVID-19 pandemic. TRIAL REGISTRATION: ISRCTN 39213655 . Registered on 11 December 2019

Study protocol for a pilot quasi-experimental study on oral health education for nurses and community health workers in Nigeria

IntroductionThe primary health care system provides an ideal setting for the integration of oral health into general health care as well as equitable access to oral health care. However, the limited oral health knowledge of primary health care workers necessitates appropriate training before they can participate in health promotion efforts. This pilot training was designed to examine the impact of the Oral Health Education module for Nurses and Community Health Care Workers on their oral health awareness and referral practices.MethodsThis study will utilize a quasi-experimental design (pre-and post with a non-equivalent control group) to assess the impact of a five-day pilot oral health education program on the knowledge and referral practices of Nurses and Community Health Workers in primary health care centers in three states in Nigeria-(Lagos, Oyo, and Kano). The training modules were developed based on the six iterative steps described in the intervention mapping framework – needs assessment, highlighting program objectives and outcomes, selection of theory and mode of intervention, designing program based on theory, designing implementation plans, and developing an evaluation plan. Only the intervention group will participate in the full educational training sessions but both groups will complete the pre-and post-intervention questionnaires.DiscussionThis pilot training combined the standardized training modules from the recently launched “Oral Health Training Course for Community Health Workers in Africa” and a newly developed maternal and child oral health module by our group using an evidence-based approach. To the best of our knowledge, this is the first program to examine the impact of the standardized OpenWHO modules. The success of this training will lay the foundation for developing a sustained channel for providing oral health education at the primary health care level in Nigeria, West Africa, and Africa

Tobacco use and other problem behaviours among street youths in South Western Nigeria

Background Young people are at a vulnerable stage of life that has been associated with initiation and addiction to tobacco and other substances. Street youths compared to their peers are prone to behavioural problems. However the association of smoking with occurrence of health-risk behaviour among street youths has been poorly documented. This study was conducted to determine the association between tobacco use and the occurrence of health-risk behaviours street youths in South-Western Nigeria. Methods A community-based cross-sectional survey was conducted among 946 consenting street youths aged 15-25 years using multi-staged sampling technique. Independent association between tobacco use and other problem behaviours was assessed using logistic regression at 5% level of significance. Results The mean age was 20.4 years (SD = 3.2), about two third were males and half of the study population were single with a partner. A higher proportion of street youths who had spent ≥ 1 year on the street were using tobacco compared to those that had spent 10 sexual partners (95% CI=1.2-5.4) and 2.2 higher odds of having had sex with commercial sex worker (95% CI=1.2-3.9) but 3.3 times less likely to use kolanut (95% CI= 0.15-0.56). Conclusions Tobacco use increases the risk of street youths engaging in other health-risk behaviours

The prospective COVID-19 vaccine: willingness to pay and perception of community members in Ibadan, Nigeria

BACKGROUND: The introduction of the COVID-19 vaccine necessitates the assessment of individual perception regarding the vaccine. This study aimed to assess the perception of community members and willingness to pay for the prospective COVID-19 vaccine in Ibadan, Nigeria. METHODS: A descriptive cross-sectional study design was used. Data were collected using an interviewer-administered questionnaire in September 2020. We studied community members aged 15 years and above using a multi-stage sampling technique. The perceptions of respondents about the COVID-19 vaccine were assessed on eight questions using the five-point Likert scale with a score point of “1” assigned for “Strongly Agree”, “2” for “Agree”, “3” for “Not decided”, “4” for “Disagree”, and “5” for “Strongly disagree”. During analysis, we reverse-coded the options by assigning a point of “1” for “Strongly disagree”, “2” for “Disagree”, “3” for “Not decided”, “4” for “Agree”, and “5” for “Strongly disagree”. However, questions asked in the negative directions were not reverse-coded during analysis. Eight questions were used to assess the perception of community members regarding the prospective COVID-19 vaccine, and overall, the maximum point was 40. Points greater than or equal to 32 points (80%) implied positive perception. Descriptive statistics were done. Chi-square tests were used for the assessment of associations between sociodemographic characteristics and willingness to pay for the prospective COVID-19 vaccine. We conducted logistic regression tests on statistically significant variables at p-values <0.05. RESULTS: The mean age of the 440 respondents studied was 37.22 ± 15.36 years, 193 (49.00%) were males, and 292 (67.30%) of the respondents had heard of the prospective COVID-19 vaccine. Among them, 232 (79.50%) respondents had positive perception regarding COVID-19 vaccine. Individuals in the fifth wealth quintile were ten times more likely to be willing to pay for the prospective COVID-19 vaccine compared to those in the first wealth quintile (Adjusted Odds Ratio = 9.57, 95% CI [2.88–31.82], p = <0.01). CONCLUSION: The prospective COVID-19 vaccine should be subsidized or made freely available to everyone