Search

A remote sensing strategy was investigated to evaluate how temperature and rainfall affect the deforestation of economically important tree species in Wudil, Kano Nigeria. The research was carried out in Wudil. To assess the vulnerability of the study area to desertification and the abundance of economic tree species. Landsat satellite products (Landsat 5, 7, 8. were used as the sources of remote sensing imageries. These products were sourced for intervals of ten years, from 1986 to 1999, 2006 to 2016, and 2020. Standardized temperature anomaly and precipitation index from 1986 to 2020 were analyzed using primary and secondary data obtained for information on temperature and rainfall, a hundred questionnaires were used to analyze how much anthropogenic activity has contributed to desertification in the area by looking at their socioeconomic activities, roads, and infrastructural development. To determine the quantity, distribution, growth, and yield of all the species, a transect of one square kilometer was surveyed using regional techniques in each of the four cardinal directions. Principal component analysis revealed that the activity variables and activity observations for 1999, 2006, 2016, and 2016 were all negative, while the years 1986 and 2020 were positive. Increased trends in temperature and decreasing trends in rainfall are evident using the Mann-Kendall analysis, with P-values of 0.0 and 0.003, respectively, which are smaller than the alpha value of 0.05. The main causes of drought and desertification vulnerability according to the findings include variations in the characteristics of rainfall, human activities, and overgrazing. More tree-planting initiatives should be encouraged, ideally making them an annual event in the study region. [ABSTRACT FROM AUTHOR]

The article discusses the family and community strategies for the care of older persons in Nigeria. It provides a background on the situation of the country's elderly, who suffer poor conditions and lack of health insurance and sponsored retirement plans from the government. Particular focus is given to the changing framework of quality social care for the elderly, which emphasizes research, legislation and a cooperative framework between family and community.

The article discusses the role of the National Universities Commission (NUC) in the development of strategies in service of older people in Nigeria. It presents information on Nigeria, and how the agenda of poverty alleviation and efficient health services intertwine with adequate social care for the elderly. Particular focus is given to the training of NUC staff in preparation for providing service to the elderly, and the development of research and teaching on ageing in Nigeria.

This paper documents the results of an intervention conducted in Nigeria to test the effectiveness of a mobile phone technology, text4life , in enabling women to self-report gender-based violence (GBV). Women experiencing GBV and other challenges related to sexual and reproductive health and rights were requested to use their mobile phones to text a code to a central server. In turn, the server relayed the messages to trained nearby health providers and civil society organization (CSO) officials who reached out to provide health care and social management services to the callers. Interviews were conducted with some callers, health care providers, and CSO staff to explore their experiences with the device. The interviews and data from the server were analyzed qualitatively and quantitatively. The results indicate that over a 27-month period, 3,403 reports were received by the server, 34.9% of which were reporting GBV. While interviewees perceived that a large proportion of the women were satisfied with the use of text4life , and many received medical treatment and psychological care, the consensus opinion was that many women reporting GBV did not wish to pursue police or legal action. This was due to women's perceptions that there would be negative cultural and social backlash should they pursue civil punishments for their partners. We conclude that a mobile phone device can be used effectively to report GBV in low-resource settings. However, the device would be more useful if it contributes to equitable primary prevention of GBV, rather than secondary prevention measures.

Background: Child marriage affects young boys and girls, especially in low and middle income countries, where it represents a dereliction of child rights, duty of care, and the promotion of public health. In Nigeria, child marriage presents a significant challenge, especially for girls, impacting education, health, and national development profoundly. Despite the importance of comprehending the effects of child marriage on health and education and quantifying its economic impact on Nigerian society through these crucial domains, there remains limited knowledge on this matter., Objective: To estimate the economic burden of child marriage to Nigerian society through its impacts on selected health and education outcomes., Participants and Setting: This analysis utilized a nationally representative sample of approximately 42,000 Nigerian households from the 2018 Nigeria Demographic and Health Survey (NDHS)., Methods: Population attributable fractions were calculated to determine the proportion of health consequences attributable to child marriage. Subsequently, disability-adjusted life years (DALYs) lost due to child marriage-related health outcomes were estimated. DALY losses were monetized by assuming one DALY equals the country's per-capita GDP. Additionally, the study investigated the impact of child marriage on girls' educational attainment and its associated reduction in earnings., Results: 42 % of Nigerian women reported child marriage. In 2019, an estimated 3489 girls died from pregnancy and childbirth resulting from child marriage. Nearly 40,000 children under the age of 5 years died in the context of child marriage. Child marriage is linked to various maternal health consequences (e.g., anemia, intimate partner violence, miscarriage/abortion/stillbirth), as well as child health consequences (e.g., overweight, anemia, low birth weight, child mortality). Additionally, child marriage decreases a girl's likelihood of completing secondary or higher education by 22.98 %, while earnings for women who married in childhood in Nigeria today are 12 % lower than what they could have been without child marriage. Failing to address child marriage could cost Nigeria over US$10 billion annually., Conclusions: There is an urgent need to overcome obstacles and integrate efforts to end child marriage into national budgets to secure a prosperous future for Nigeria., Competing Interests: Declaration of competing interest The authors have no conflicts of interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: In 2019, Nigeria reported the highest mortality rate in children younger than 5 years globally. We aimed to assess a whole-systems approach to improving child mortality in northern Nigeria., Methods: We conducted a community-based, parallel-arm, pragmatic, cluster randomised controlled trial in Kiyawa local government area, Jigawa state, Nigeria, and a concurrent mixed-methods process evaluation using ethnography and quantitative implementation monitoring. Trial clusters were population catchment areas of 32 government primary health-care facilities. Compounds were randomly sampled, proportional to cluster size, and all women aged 16-49 years and children younger than 5 years who were permanent residents were eligible for inclusion and recruited as the evaluation population. Children younger than 7 days were recruited but excluded from analysis. Evaluation clusters were allocated to intervention or control via simple randomisation with a 1:1 ratio. Cluster names were written on paper, folded, and placed in a container by community representatives. Different community representatives took out names one by one, with the first half assigned to receive the intervention. The intervention consisted of three components: participatory learning and action (PLA) groups for men and women (including compound heads [ie, the member of the compound that residents deemed most senior]), partnership defined quality scorecard (PDQS), and health-care worker capacity building; it was delivered from March 1, 2021, to Dec 31, 2022. We could not mask participants, field staff, or intervention-delivery staff to cluster allocation but baseline, endline, and follow-up data excluded information on cluster allocation. PLA groups involved separate groups of up to 25 men or women from all villages in the intervention clusters. The primary outcome was all-cause mortality in children aged 7 days to 59 months between Oct 1, 2021, and Sept 20, 2022, referred to as the evaluation period. The trial was prospectively registered (ISRCTN 39213655) and the protocol has been published., Findings: We recruited 3800 compounds at baseline, with 12 893 children contributing to analysis of the primary outcome (7316 [56·8%] of 12 893 in the intervention group and 5577 [43·3%] in the control group). 6617 (51·3%) of 12 893 children were male, 6275 (48·7%) were female, and one (<0·1%) child had missing sex data. Sampled compounds randomly came from 388 (91·3%) of 425 villages in the 32 clusters. We conducted verbal autopsies for 1182 deaths, of which 369 (31·2%) were children aged 7 days to 59 months during the evaluation period. Of these 369, 91 (24·7%) were classified as pneumonia deaths. Children contributed a median 361 days (IQR 236-365) to the analysis, with 369 (2·9%) of 12 893 children censored on their date of death, 1545 (12·0%) on their 5th birthday, and 3392 (26·3%) on the date of the most recent follow-up in which their residence or survival status was known. We found no significant decrease in all-cause mortality (hazard ratio 0·95, 95% CI 0·68-1·33; p=0·79) or suspected pneumonia mortality (0·79, 0·43-1·46; p=0·46) in the intervention group. The process evaluation showed low coverage and issues in reach of the intervention, but qualitative data highlighted mechanisms for positive effects on health and relationships., Interpretation: Our intervention did not affect mortality. However, due to the high child mortality in this region, further efforts should be made to adapt our participatory whole-systems approach to use communities of action within compounds., Funding: GSK and Save the Children UK., Translation: For the Hausa translation of the abstract see Supplementary Materials section., Competing Interests: Declaration of interests HRG, EDM, and CK are advisors to Lifebox Foundation. AAB, AGF, and HRG are board members for the Oxygen for Life Initiative, which has provided oxygen-training services to the INSPIRING project. SA, TA, and PV are employees of Save the Children UK, part of the partnership funding for this trial and evaluation. TFO and MM are employees of and stockholders in GSK, part of the partnership funding for this trial and evaluation. All other authors declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Conducting randomized clinical trials (RCTs) during a pandemic is essential for obtaining timely evidence on safe and effective treatments, but it presents numerous obstacles. During the COVID-19 pandemic, the World Health Organization (WHO) sponsored multinational RCTs investigating repurposed drugs among hospitalized COVID-19 patients across countries with varying clinical research capacities. In Nigeria, several challenges hindered our progress, including inadequate infrastructure, initial insufficient investigator certification and expertise, and delays in securing regulatory approvals due to bureaucratic hurdles. Despite these challenges, the WHO-sponsored Solidarity Plus Trial (SPT) offered valuable opportunities to enhance research capacity, streamline participant enrolment through electronic randomization, and bolster infection prevention and control measures for healthcare workers. Moreover, the trial enabled us to upgrade infrastructure at multiple sites, facilitating improved case detection through more testing and data collection. A crucial lesson learned was the importance of expediting trial initiation to capitalize on the limited window for data collection during an outbreak. To optimize RCTs during pandemics, we advocate for enhanced community engagement, collaborative efforts across sectors, strengthened research capacity, flexible regulatory frameworks, and the establishment of adaptive clinical trial units. By addressing these challenges and leveraging opportunities, we can significantly enhance the efficiency and impact of RCTs during public health emergencies., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The author (AGH) is an Editorial Board Member/Editor-in-Chief/Associate Editor/Guest Editor for [PLoS Neglected Tropical Diseases; Toxicon; Toxin Reviews] and was not involved in the editorial review or the decision to publish this article., (Copyright © 2024. Published by Elsevier Inc.)

Background: Timely access to safe blood and blood components is still a challenge in Nigeria. This study aimed to determine blood donation practices, processing and utilization of blood components across government tertiary hospitals (THs) in Nigeria., Methods: This was a descriptive cross-sectional study done in Nigeria in June-July 2020. Data were analysed with SPSS version 21.0., Results: Data were collected from 50 THs. The majority (68%) of the THs lack facilities for blood component preparation and only 18% and 32% provide cryoprecipitate and platelet concentrate, respectively. Whole blood was most commonly requested (57.04%). All facilities tested blood for HIV, HBV and HCV, but the majority (23 [46%]) employed rapid screening tests alone and nucleic acid testing was not available in any hospitals. The manual method was the most common method of compatibility testing in 90% (45/50) and none of the THs routinely perform extended red cell typing. The average time to process routine, emergency and uncross-matched requests were a mean of 109.58±79.76 min (range 45.00-360.00), 41.62±25.23 (10.00-240.00) and 11.09±4.92 (2.00-20.00), respectively., Conclusion: Facilities for blood component preparation were not widely available. Concerned government authorities should provide facilities for blood component preparation., (© The Author(s) 2023. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)

Objectives: To assess burn injury knowledge and its predictors among reproductive-age women attending an urban and a semi-rural hospital in Northwest Nigeria DESIGN: A descriptive cross-sectional study SETTING: It was conducted in the general and paediatric outpatient clinics of Aminu Kano Teaching Hospital in Kano (urban setting) and the general outpatient, paediatric outpatient and antenatal clinics of Federal Medical Centre Birnin Kudu (semi-rural setting)., Participant: In 2021, 362 women aged 18-44 years were randomly selected from clinic attendees over six weeks. Of them, 217 were from the urban hospital. Data regarding their sociodemographic characteristics and knowledge of burn injuries was collected using a pretested, semi-structured interviewer-administered questionnaire., Outcome Measure: Knowledge of burn injuries RESULTS: About 83.4 %, 77.1 % and 77.6 % of respondents had adequate general, primary prevention and overall knowledge of burn injuries, respectively. Their mean overall knowledge score was 18.6 out of 24, but only 55.5 % had adequate first-aid knowledge. The study sites did not significantly differ in burns first-aid, prevention and overall knowledge scores. However, urban respondents were more ignorant about the cause of burns and knew that burn injuries could be fatal. More semi-rural respondents knew that flames and chemicals cause burn injuries. Predictors of overall knowledge were age, educational level, number of children in their household, previously seeing a burn-injured child, and primary source of burns-related information., Conclusions: The proportion of respondents with adequate overall burn injury knowledge was high; however, knowledge gaps exist among them. Overall, their first-aid knowledge was relatively low. The urban and semi-rural respondents had no significant differences in first-aid, prevention, or overall knowledge of burn injuries. However, knowledge of the causes of burns and burn complications differed between the urban and semi-rural study locations. Therefore, the clinical settings of this study present opportunities for similar burn-related educational interventions., (Copyright © 2024 Elsevier Ltd and ISBI. All rights reserved.)

Effective solid waste management is a critical environmental challenge, particularly in rapidly growing Global South countries like Nigeria. This issue is exacerbated by burgeoning populations, lax waste regulations, and the widespread practice of open dumping. The deterioration of soil quality and alteration of water quality are major consequences of open waste dumping, posing significant environmental and public health risks. This study aims to assess the environmental risk and pollution status of soil and water resources near major dumpsites in Lagos. It aims to offer insights that can inform targeted interventions and policy measures not only in Lagos but also in comparable urban settings worldwide. Results indicated that important soil parameters, including TN (11.89-13.83 mg/kg), pH (6.45-7.35), sulfate (36.71-39.49 mg/kg), phosphate (9.31-14.39 mg/kg), and electrical conductivity (342-566 µS/cm), were significantly affected by the dumpsites. Additionally, concentrations of heavy metals varied, with some exceeding permissible limits set by international standards, highlighting the environmental challenges posed by improper waste disposal in urban settings like Lagos. The analyzed parameters for water were mostly within acceptable limits, indicating a lesser impact of the waste dump on water resources. Water samples from boreholes and hand-dug wells near three dumpsites showed that pH, TDS, and heavy metal concentrations were mostly within WHO limits, with borehole water deemed safe for drinking and hand-dug wells suitable for cleaning. To alleviate the environmental impacts of open dumpsites, it is recommended to implement effective waste segregation, recycling programs, controlled landfilling, and investment in waste treatment technologies, along with regular water quality monitoring to prevent further pollution and protect public health. While these measures offer opportunities, they also face significant challenges due to financial and land constraints. Therefore, strong public awareness, infrastructure investment, and government commitment are essential, along with coordinated efforts among the government, private sector, and communities., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: Adverse events following immunization (AEFIs), especially if serious, may impact vaccine recipients' quality of life and financial well-being and fuel vaccine hesitancy. Nigeria rolled out COVID-19 vaccination in 2021 with little known about the impact of AEFIs on an individual's quality of life. No study in Africa has explored the health and financial impact of AEFIs. We explored patient-reported outcomes (PROs) of adverse events after COVID-19 vaccination and documented the lived experiences of those with serious AEFIs to understand the effect on their health, financial well-being, and attitude to future vaccinations., Methods: We conducted a convergent mixed-methods study using the RAND 36-item health survey and in-depth interviews to collect PROs on vaccine recipients in Nigeria. Eight health scale scores and two summary composite scores were used to measure the health-related quality of life outcomes from the survey and inductive analysis was used to identify themes from the interview scripts. The results of both studies were integrated in a joint display to highlight areas of concordance., Results: In total, 785 survey responses were analyzed (53% females, 68% aged 18-30 years). Responders reporting an AEFI were 58%, of whom 62% received the first dose only. Younger age and first vaccine dose (p < .001 respectively) were associated with experiencing an AEFI. Not reporting an AEFI was associated with better quality of life, measured as higher scores on all eight SF-36 Health scales and the physical and mental component summary scores. All six interviewees with serious AEFIs experienced physical, mental, and financial distress. Some expressed a strong negative attitude toward future COVID-19 vaccinations but not toward vaccines for routine immunization., Conclusion: AEFIs negatively impact the health and financial well-being of affected individuals and their attitude to future vaccinations, especially if serious. Understanding the impact of AEFIs on people is important and should inform future policies and interventions. The results of our study can inform policy and planning for future mass vaccination campaigns in LMICs., Competing Interests: Declaration of competing interest The authors declare that they have no competing financial or personal interests that could have influenced the work., (Copyright © 2024. Published by Elsevier Ltd.)

Objective: To estimate the prevalence of obstructed labour, associated risk factors and outcomes across a network of referral hospitals in Nigeria., Design: Retrospective observational study., Setting: A total of 54 referral-level hospitals across the six geopolitical regions of Nigeria., Population: Pregnant women who were diagnosed with obstructed labour during childbirth and subsequently underwent an emergency caesarean section between 1 September 2019 and 31 August 2020., Methods: Secondary analysis of routine maternity care data sets. Random-effects multivariable logistic regression was used to ascertain the factors associated with obstructed labour., Main Outcome Measures: Risk factors for obstructed labour and related postpartum complications, including intrapartum stillbirth, maternal death, uterine rupture, postpartum haemorrhage and sepsis., Results: Obstructed labour was diagnosed in 1186 (1.7%) women. Among these women, 31 (2.6%) cases resulted in maternal death and 199 (16.8%) cases resulted in postpartum complications. Women under 20 years of age (OR 2.03, 95% CI 1.50-2.75), who lacked formal education (OR 1.88, 95% CI 1.55-2.30), were unemployed (OR 1.94, 95% CI 1.57-2.41), were nulliparous (OR 2.11, 95% CI 1.83-2.43), did not receive antenatal care (OR 3.34, 95% CI 2.53-4.41) or received antenatal care in an informal healthcare setting (OR 8.18, 95% CI 4.41-15.14) were more likely to experience obstructed labour. Ineffective referral systems were identified as a major contributor to maternal death., Conclusions: Modifiable factors contributing to the prevalence of obstructed labour and associated adverse outcomes in Nigeria can be addressed through targeted policies and clinical interventions., (© 2024 John Wiley & Sons Ltd.)

Background: Kidney transplantation is the best mode of kidney replacement therapy. However, the shortage of organ donations has been a major challenge globally. Relatives of patients with end-stage kidney disease (ESKD) are potential kidney donors. We explored their perspectives about kidney donation, kidney commercialisation, and barriers to kidney donation., Methods: In-depth interviews were conducted among 28 relatives of ESKD patients across the six geopolitical zones and Federal Capital Territory of Nigeria. The interview focused on potential sources of kidney donors, kidney commercialisation and barriers to kidney donation. ATLAS.ti version 9.0.22.0 was used for data analysis., Results: Mean age of the study participants was 41.57 ± 14.55 years; 54% were females, 60.7% were married, 93% had tertiary education and 75% were first degree relatives of ESKD patients. There were 7 themes and 28 subthemes generated in this study. The potential sources of kidney donors identified by the study participants included commercial, hospital, family and non-family member donors. While some opined that a family member is the best choice as a kidney donor, others preferred a commercial donor. The majority of those interviewed do not believe that it is wrong to purchase a kidney, and would be willing to do so. Identified factors that promote kidney commercialisation were unwillingness of a family member to donate, having the financial capacity to purchase a kidney, non-fitness of family members to donate. Identified barriers to kidney donation were age, poor health status, polygamy, perceived poor expertise of the medical team, perceived risk of the procedure, parental influence and religious beliefs., Conclusions: The majority of participants lacked correct information about kidney donation. Implementation of educational program policies and laws regulating and reinforcing ethical principles of kidney donation and transplantation should be ensured., (© 2024. The Author(s) under exclusive licence to Italian Society of Nephrology.)

Background: Little is known regarding economic impacts of intimate partner violence (IPV) in humanitarian settings, especially the labor market burden. Examining costs of IPV beyond the health burden may provide new information to help with resource allocation for addressing IPV, including within conflict zones. This paper measures the incidence and prevalence of different types of IPV, the potential relationship between IPV and labor market activity, and estimating the cost of these IPV-associated labor market differentials., Methods: The association between labor market outcomes, IPV experience, and conflict exposure among women ages 15-49 in Nigeria were studied using the 2018 Nigeria Demographic and Health Survey and 2013-17 Uppsala Conflict Data Program data. Descriptive analysis was used to identify patterns of IPV and labor outcomes by region. Based on this, multivariable logistic regression models were used to estimate the association between labor market participation and lifetime IPV exposure. These models were combined with earnings data from the United Nations Human Development Report 2021/2022 and a top-down costing approach to quantify the impacts in terms of lost productivity to the Nigerian economy., Results: Substantial differences in IPV exposure and labor market outcomes were found between conflict and non-conflict-affected areas. Women with past year or lifetime exposure to physical, emotional, or "any" IPV were more likely to withdraw from the labor market in the past year, although no differences were found for sexual IPV or conflict-affected regions. We estimate an average reduction of 4.14% in the likelihood of working, resulting in nearly $3.0 billion USD of lost productivity, about 1% of Nigeria's total economic output., Conclusions: Increased odds of labor market withdraw were associated with several measures of IPV. Withdrawal from the formal labor market sector has a substantial associated economic cost for all of Nigerian society. If stronger prevention measures reduce the incidence of IPV against women in Nigeria, a substantial portion of lost economic costs likely could be reclaimed. These costs underscore the economic case, alongside the moral imperative, for stronger protections against IPV for girls and women in Nigeria., (© 2024. The Author(s).)

In 2016, the World Health Organization introduced global targets for the care and management of hepatitis C virus (HCV) infection to eliminate hepatitis C as a public health threat by 2030. Despite significant improvements in testing and treatment, in 2020 only 23% of all persons infected with HCV globally were diagnosed. We explore examples from global hepatitis C programs in Georgia, Rwanda, and Nigeria that have used decentralized and integrated models to increase access to HCV testing. Georgia established the world's first national hepatitis C elimination program in 2015. In 2022, 2.6 million people (80% of the adults) have been screened for antibodies for HCV infection, and 80 000 persons with HCV RNA detected were treated. To achieve these results, Georgia implemented HCV core antigen testing, utilization of point-of-care (POC) HCV RNA testing, and simplification of HCV viremia detection by qualitative HCV RNA testing. Rwanda was the first country in sub-Saharan Africa to commit to HCV elimination in 2018, and as of 2022 it has achieved its screening target of 7 million people and initiated approximately 60 000 patients on hepatitis C treatment by rapid decentralization and integration of HCV services. In Nigeria, the integrated near-POC testing approach in Nasarawa State has been effective in expanding access to HCV viremia testing and enabling the possibility of same-day testing and treatment initiation. Examples of decentralization and integration of HCV testing and linkage to care in Georgia, Rwanda, and Nigeria could help inform effective strategies to reach 2030 hepatitis C elimination goals in other countries., Competing Interests: Potential conflicts of interest. All authors: No reported conflicts of interest., (© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)

Although a sizable number of pregnant women patronize Traditional Birth Attendants (TBAs) for deliveries in Nigeria, efforts to prevent or reduce the risk of HBV transmission are not targeted at the TBAs and the pregnant women patronizing them. This may be linked to the dearth of information on the serological profiles of HBV among this cohort. We, therefore, show the serological profiles of HBV among the cohort. One hundred and seventy pregnant women and 91 TBAs participated in this study between May and July 2019. Serological markers of HBV infection were assayed using ELISA. A prevalence of, 8.0% (95% CI: 5.0% - 11.5%) for HBsAg, 0.8% (95% CI: 0.0% - 1.9%) for HBeAg, 2.7% (95% CI: 0.8% - 5.0%) for HBcIgM, 26.1% (95% CI: 20.7% - 31.4%) for anti-HBs, 21.5% (95% CI: 16.5% - 25.4%) for anti-HBe and 67.0% (95% CI: 60.9% - 72.8%) for anti-HBc was found indicating a high percentage of carriers. Although 32 (12.3%) of the entire participants claimed to be fully vaccinated, serological evidence was only detected in 4 (12.5%). The high percentage of carriers and low evidence of vaccination necessitate intensified efforts to ensure that adequate interventions are made available and accessible to the TBAs and the pregnant women patronizing them (including newborn babies).

Introduction: the availability of oocytes is fundamental to in vitro fertilization (IVF). The factors associated with optimal or suboptimal oocyte recovery rates (ORR) in low-resource settings are not well known. This study aimed to determine the factors associated with ORR by comparing demographic and IVF cycle data of women undergoing IVF in our Centre., Methods: this was a prospective study of 110 infertile women undergoing IVF at Nisa Premier Hospital, Abuja Nigeria, from October 2020 to September 2021. All women had reached the stage of oocyte retrieval or further, after receiving ovarian stimulation with our routine protocols. Treatment was monitored by serial transvaginal ultrasonography. The oocyte retrieval procedures were performed under conscious sedation, 36 hours after the ovulatory trigger. Optimal ORR was when eggs were obtained from at least 80% of follicles punctured. Sub-optimal ORR was when it was less than 80%. Data analyses utilized SPSS statistical software and a p-value of < 0.05 was considered significant., Results: the mean age of all women was 34.1±4.9 years. Sixty-nine women (62.7%) had sub-optimal ORR while 41 (37.3%) had optimal ORR. Six women (5.5%) had no oocytes retrieved. Significantly more women with sub-optimal ORR were obese (70.6 vs 29.4%) and had higher follicle-stimulating hormone (FSH) levels (8.11 vs 6.34 miu/ml), p-value- 0.039. Women with sub-optimal ORR had higher mean prolactin levels (17.10 ± 13.93 miu/ml) than women with optimal ORR 11.43 ± 6.65 miu/ml), p-value- 0.019). Significantly more oocytes (5.99 vs 10.37, p-value 0.001), and MII oocytes (5.78 vs 7.56, p-value 0.035) were retrieved in women with optimal than sub-optimal ORR. The duration of stimulation, total amounts of gonadotropins administered, and fertilized oocytes were not significantly different among both groups (p-value >0.05)., Conclusion: this study has shown the factors associated with ORR in our setting to be basal FSH, prolactin, and obesity., Competing Interests: The authors declare no competing interests., (Copyright: Amina Mohammed-Durosinlorun et al.)

Background: The increasing prevalence of obesity and overweight among health workers calls for an appraisal of their lifestyle. This study assessed medical practitioners' workhour feeding and lifestyle practices and explored the relationship between these practices and their body mass index (BMI)., Methods: The survey involved 321 medical practitioners selected from 9 northern Nigeria hospitals in 2021. Data collected included biodata, medication history, workhour feeding characteristics, lifestyle behaviours, blood pressure, height, and weight measurements. Data were analyzed using Epi info software (version 7)., Results: Most respondents were male (70.7%). Their mean age was 38 ± 7.4 years. During their last workhours, 84.1% had lunch, and 46.4% took sugary drinks. Usually, 41.7% source their lunch from the hospital canteen, and 18.7% patronize their canteen at least weekly. Most reported healthy behaviour towards alcohol consumption (99.7%), fruit and vegetable consumption (54.8%) and smoking (98.4%). However, only 22.4% were physically active. Their mean healthy behaviour score and BMI were 2.8 ± 0.7 and 26.1 ± 4.6 kg/m 2 , respectively. The obesity and overweight rates were 18.4% and 37.7%, respectively. Their source of lunch during workhours, age, sex, years of practice, employment duration, marital status, job category, systolic blood pressure, anti-hypertensive, and antidiabetic medication use were significantly associated with mean BMI. However, only antihypertensive medication use, being married, inadequate fruit/vegetable consumption and workhour sugary drinks consumption predicted obesity. The predictors of overweight/obese were years of practice (< 10 y) and use of antihypertensive medications., Conclusions: Obesity and overweight rates were high. Most were physically inactive. Workhour sugary drink consumption predicted obesity. Effective workplace and community interventions to improve practitioners' lifestyle behaviour and curtail obesity and overweight are needed., Competing Interests: The authors declare that no conflict of interest exists., (©2024 Pacini Editore SRL, Pisa, Italy.)

The attainment of the global target of zero dog-mediated human rabies by 2030 depends on functional rabies programmes. Nigeria, a rabies-endemic country, and the most populous country in Africa has a very poor rabies control strategy with a score of 1.5 out of 5 based on the Stepwise Approach towards Rabies Elimination (SARE). In this article, we report a scoping review that we conducted to highlight the strengths, weaknesses, opportunities and threats as well as situational analysis of rabies control in Nigeria and suggest a timeline for key activities that are needed to ensure zero by 30. Our findings reveal that rabies is grossly under-reported as only 998 human and 273 dog-suspected rabies cases were reported across Nigeria between 2017 and 2022. Our literature review also demonstrates a paucity of information on rabies in both human and animal health sectors. A total of 49 studies on dog rabies in Nigeria, with a predominance of reports from the North Central geopolitical region (48%, n = 23) were therefore included in this study. Currently, only 16.2% (n = 6/37) of Nigerian states have available data related to the estimated dog populations, the dog ownership rates, the vaccination status of dogs or the incidence of dog bites. Based on a dog-to-human ratio of 1:16.3, we estimated that the dog population in Nigeria was 12,969,368 (95% CI: 12,320,900-13,617,836). Thus, to attain herd immunity and dog rabies control in Nigeria, at least 9.1 million dogs must be vaccinated annually. Our review reveals that, despite the strengths and available opportunities to achieve rabies control in Nigeria by 2030, the weaknesses and challenges will make the attainment of zero by 30 very difficult or impossible. Nigeria's best-case scenario by the year 2030 is SARE stage 3-4 (control-elimination) out of 5. Otherwise, the rabies control programme might not surpass SARE stages 2-3. To attain zero by 30, Nigeria must re-strategize its current rabies control programme by funding and implementing the national strategic plan for rabies control, creating a rabies desk office in the 37 states (FCT inclusive), rigorously conducting mass vaccination campaigns, providing post-exposure prophylaxis, prioritizing mass enlightenment with a focus on responsible pet ownership and conduct baseline national rabies surveillance in the animal and human health sectors., (© 2023 The Authors. Zoonoses and Public Health published by Wiley-VCH GmbH.)

Purpose: Post-traumatic stress disorder (PTSD) is a severe anxiety disorder that can develop due to exposure to any event that may result in psychological trauma. This study compared the effect of interactive audio-visual-based art and music therapy in reducing post-traumatic stress disorder in adolescents who survived abduction in Nigeria., Methods: A quasiexperiment was carried out in two selected secondary schools in Northern Nigeria. The study sample comprised 470 students randomly divided into a control group of 235 and an experiment group of 235. The treatment group was further divided into art 118 and music 117 therapy groups, respectively., Results: Results suggest that interactive audio-visual art therapy and music therapy is an effective intervention strategy for reducing the PTSD of school adolescents that have experienced kidnapping in Nigeria. However, art therapy is more effective in reducing PTSD than music therapy., Discussion: We recommend the introduction of audio-visual-based music and art therapy to reduce the PTSD of adolescents that survived kidnapping in Nigeria. More focus should be made on art therapy, which is more effective in curtailing adolescents PTSD., (Copyright © 2023 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Introduction: Recent outbreaks of mpox are characterised by changes in the natural history of the disease, the demographic and clinical characteristics of the cases, and widening geographical distribution. We investigated the role of HIV and other sexually transmitted infections (STIs) coinfection among cases in the re-emergence of mpox to inform national and global response., Methods: We conducted a national descriptive and case-control study on cases in the 2017-2019 Nigerian mpox outbreak. Mpox cases were age, sex and geographical area matched each with two randomly selected controls from a representative national HIV/AIDS survey. Logistic regression was used to investigate the association between HIV infection and the risk of mpox acquisition and death., Results: Among 204 suspected mpox cases, 86 were confirmed (median age 31 years (IQR 27-38 years), mostly males (61 cases, 70.9%). Three-fifths of mpox cases had serological evidence of one or more STIs with 27.9% (24/86) coinfected with HIV. The case fatality rate was 9.4% (8/86) and 20.8% (5/24) overall and in HIV positive cases respectively. Mpox cases were more likely to have HIV coinfection compared with an age, gender and geography-matched control group drawn from the general population (OR 45 (95% CI 6.1 to 333.5, p=0.002) and when compared with non mpox rash cases (7.29 (95% CI 2.6 to 20.5, p<0.0001)). HIV coinfection and young age were associated with mortality among mpox cases (aOR 13.66 (95% CI 1.88 to 98.95, p=0.010) and aOR 0.90 (0.82-0.97, p=0.008), respectively)., Conclusion: HIV infection was associated with a higher risk of contracting and dying from mpox. Children are also at high risk of death. STIs in mpox cases may be suggestive of high-risk sexual behaviours among these individuals., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Background and Objectives: Menstruation is a natural occurrence marked by the periodic release of endometrial cells within the uterine lining from the female genital area. Menstruation knowledge remains highly essential for young adolescents. Inadequate awareness and understanding of menstruation have far-reaching consequences on the overall wellbeing and health outcomes of young adults worldwide. Adolescent girls make up a large percentage of high school students in Nigeria. Girls in countries with low to middle incomes are frequently misled or uneducated regarding menstruation. Menstrual health literacy (MHL) is the level of knowledge concerning matters related to menstrual health. It is observed that a lack of menstrual health literacy is seen among young adults. This systematic review aimed to examine menstruation literacy, attitudes, and adolescent girls' practices in Nigeria. Materials and Methods: This systematic review included quantitative, cross-sectional, quasi-experimental, and qualitative primary research studies relating to menstruation literacy, attitudes, and practices of adolescents in Nigeria. Articles for this study were searched for on databases such as PubMed and BioMed Central using keywords. These studies were subjected to stringent inclusion and exclusion criteria where the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used, and 13 articles were included after critical appraisal. Data extracted were analysed using narrative synthesis. Results: Findings indicated that knowledge regarding menstruation among adolescents (82.6%) was poor. Menstruation information was obtained from mothers, which was positive as some adolescents reported their closeness to their mothers. Regarding attitudes towards menstruation among adolescents, it was reported that more respondents (70.3%) had negative attitudes towards menstruation. Conclusions: Most of the respondents in Nigeria were not adequately prepared for the onset of their first menstrual period. Knowledge and attitude levels were low regarding periods for adolescents. The only exception was their positive attitude towards using water and soap to wash their hands during menstruation. The review shows a significant gap between adolescents' menstruation knowledge and actual hygienic methods during menstruation. It is therefore required for educational awareness programmes and campaigns to be put in place to educate adolescents about menstruation.

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., Competing Interests: Competing interests: HG, EDM and CK are advisors to Lifebox Foundation on pulse oximetry. AAAB, AGF and HG are board members for Oxygen for Life Initiative, a private non-profit that has provided services to the INSPIRING Project. PV is employed by Save the Children UK which is part of the partnership funding the research., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Based on 2021 data, Nigeria had the second largest number of zero-dose children globally estimated at over 2.25 million, concentrated in the northern part of the country due to factors some of which are sociocultural. This study analysed the impact of the COVID-19 pandemic and response on childhood vaccination in Northern Nigeria., Methods: Using a mixed methods sequential study design in the most populous northern states of Kaduna and Kano, quantitative routine immunisation data for the period 2018-2021 and qualitative data collected through 16 focus group discussions and 40 key informant interviews were used. An adaptation of the socioecological model was used as a conceptual framework. Mean vaccination coverages and test of statistical difference in childhood vaccination data were computed. Qualitative data were coded and analysed thematically., Results: Mean Penta 1 coverage declined in Kaduna from 69.88% (SD=21.02) in 2018 to 59.54% (SD=19.14%) by 2021, contrasting with Kano where mean Penta 1 coverage increased from 51.87% (SD=12.61) to 56.32% (SD=17.62%) over the same period. Outreaches and vaccination in urban areas declined for Kaduna state by 10% over the pandemic period in contrast to Kano state where it showed a marginal increase. The two states combined had an estimated 25% of the country's zero-dose burden in 2021. Lockdowns, lack of transport and no outreaches which varied across the states were some of the factors mentioned by participants to have negatively impacted childhood vaccination. Special vaccination outreaches were among the recommendations for ensuring continued vaccination through a future pandemic., Conclusion: While further interrogating the accuracy of denominator estimates for the urban population, incorporating findings into pandemic preparedness and response will ensure uninterrupted childhood vaccination during emergencies. Addressing the identified issues will be critical to achieving and sustaining universal childhood vaccination in Nigeria., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Timely and reliable data are crucial for clinical, epidemiologic, and program management decision making. Electronic health information systems provide platforms for managing large longitudinal patient records. Nigeria implemented the National Data Repository (NDR) to create a central data warehouse of all people living with human immunodeficiency virus (PLHIV) while providing useful functionalities to aid decision making at different levels of program implementation., Objective: We describe the Nigeria NDR and its development process, including its use for surveillance, research, and national HIV program monitoring toward achieving HIV epidemic control., Methods: Stakeholder engagement meetings were held in 2013 to gather information on data elements and vocabulary standards for reporting patient-level information, technical infrastructure, human capacity requirements, and information flow. Findings from these meetings guided the development of the NDR. An implementation guide provided common terminologies and data reporting structures for data exchange between the NDR and the electronic medical record (EMR) systems. Data from the EMR were encoded in extensible markup language and sent to the NDR over secure hypertext transfer protocol after going through a series of validation processes., Results: By June 30, 2021, the NDR had up-to-date records of 1,477,064 (94.4%) patients receiving HIV treatment across 1,985 health facilities, of which 1,266,512 (85.7%) patient records had fingerprint template data to support unique patient identification and record linkage to prevent registration of the same patient under different identities. Data from the NDR was used to support HIV program monitoring, case-based surveillance and production of products like the monthly lists of patients who have treatment interruptions and dashboards for monitoring HIV test and start., Conclusion: The NDR enabled the availability of reliable and timely data for surveillance, research, and HIV program monitoring to guide program improvements to accelerate progress toward epidemic control., Competing Interests: None declared., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Background: In Nigeria, results from the pilot of the Test and Treat strategy showed higher loss to follow up (LTFU) among people living with HIV compared to before its implementation. The aim of this evaluation was to assess the effects of antiretroviral therapy (ART) initiation within 14 days on LTFU at 12 months and viral suppression., Methods: We conducted a retrospective cohort study using routinely collected de-identified patient-level data hosted on the Nigeria National Data Repository from 1,007 facilities. The study population included people living with HIV age ≥15. We used multivariable Cox proportional frailty hazard models to assess time to LTFU comparing ART initiation strategy and multivariable log-binomial regression for viral suppression., Results: Overall, 26,937 (38.13%) were LTFU at 12 months. Among individuals initiated within 14 days, 38.4% were LTFU by 12 months compared to 35.4% for individuals initiated >14 days (p<0.001). In the adjusted analysis, individuals who were initiated ≤14 days after HIV diagnosis had a higher hazard of being LTFU (aHR 1.15, 95% CI 1.10-1.20) than individuals initiated after 14 days of HIV diagnosis. Among individuals with viral load results, 86.2% were virally suppressed. The adjusted risk ratio for viral suppression among individuals who were initiated ≤14 days compared to >14 days was not statistically significant., Conclusion: LTFU was higher among individuals who were initiated within 14 days compared to greater than 14 days after HIV diagnosis. There was no difference for viral suppression. The provision of early tailored interventions to support newly diagnosed people living may contribute to reducing LTFU., Competing Interests: The authors have declared that no competing interests exist., (Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.)

Background: Current debates in Global Health call for expanding methodologies to allow typically silenced voices to contribute to processes of knowledge production and intervention design. Within trial research, this has typically involved small-scale qualitative work, with limited opportunities for citizens to contribute to the structure and nature of the trial. This paper reports on efforts to move past typical formative trial work, through adaptation of community conversations (CCs) methodology, an action-oriented approach that engages large numbers of community members in dialogue. We applied the CC method to explore community perspectives about pneumonia and managing the health of children under-5 in Northern Nigeria to inform our pragmatic cluster randomised controlled trial evaluating a complex intervention to reduce under-5 mortality in Nigeria., Methods: We conducted 12 rounds of community conversations with a total of 320 participants, in six administrative wards in Kiyawa Local Government Area, Jigawa state, our intervention site. Participants were male and female caregivers of children under five. Conversations were structured around participatory learning and action activities, using drawings and discussion to reduce barriers to entry. During activities participants were placed in subgroups: younger women (18-30 years of age), older women (31-49 years) and men (18 years above). Discussions were conducted over three 2-h sessions, facilitated by community researchers. Following an initial analysis to extract priority issues and perspectives on intervention structure, smaller focus group discussions were completed with participants in five new sites to ensure all 11 administrative wards in our study site contributed to the design., Results: We identified enabling and limiting factors which could shape the future trial implementation, including complex power relationships within households and wider communities shaping women's health decision-making, and the gendered use of space. We also noted the positive engagement of participants during the CC process, with many participants valuing the opportunity to express themselves in ways they have not been able to in the past., Conclusions: CCs provide a structured approach to deep meaningful engagement of everyday citizens in intervention and trial designs, but require appropriate resources, and commitment to qualitative research in trials., Trial Registration: ISRCTN39213655. Registered on 11 December 2019., (© 2023. The Author(s).)

Background: For their 2021-2025 National Malaria Strategic Plan (NMSP), Nigeria's National Malaria Elimination Programme (NMEP), in partnership with the World Health Organization (WHO), developed a targeted approach to intervention deployment at the local government area (LGA) level as part of the High Burden to High Impact response. Mathematical models of malaria transmission were used to predict the impact of proposed intervention strategies on malaria burden., Methods: An agent-based model of Plasmodium falciparum transmission was used to simulate malaria morbidity and mortality in Nigeria's 774 LGAs under four possible intervention strategies from 2020 to 2030. The scenarios represented the previously implemented plan (business-as-usual), the NMSP at an 80% or higher coverage level and two prioritized plans according to the resources available to Nigeria. LGAs were clustered into 22 epidemiological archetypes using monthly rainfall, temperature suitability index, vector abundance, pre-2010 parasite prevalence, and pre-2010 vector control coverage. Routine incidence data were used to parameterize seasonality in each archetype. Each LGA's baseline malaria transmission intensity was calibrated to parasite prevalence in children under the age of five years measured in the 2010 Malaria Indicator Survey (MIS). Intervention coverage in the 2010-2019 period was obtained from the Demographic and Health Survey, MIS, the NMEP, and post-campaign surveys., Results: Pursuing a business-as-usual strategy was projected to result in a 5% and 9% increase in malaria incidence in 2025 and 2030 compared with 2020, while deaths were projected to remain unchanged by 2030. The greatest intervention impact was associated with the NMSP scenario with 80% or greater coverage of standard interventions coupled with intermittent preventive treatment in infants and extension of seasonal malaria chemoprevention (SMC) to 404 LGAs, compared to 80 LGAs in 2019. The budget-prioritized scenario with SMC expansion to 310 LGAs, high bed net coverage with new formulations, and increase in effective case management rate at the same pace as historical levels was adopted as an adequate alternative for the resources available., Conclusions: Dynamical models can be applied for relative assessment of the impact of intervention scenarios but improved subnational data collection systems are required to allow increased confidence in predictions at sub-national level., (© 2023. The Author(s).)

There are conflicting reports on trends of semen parameters from different parts of the globe. However, in recent times there is dearth of information on the trend in Sub-Saharan countries. Therefore, in this study we aimed at determining the trends in semen parameters in Nigeria and South Africa between 2010 and 2019. A retrospective study of semen analyses of 17,292 men attending fertility hospitals in Nigeria and South Africa in 2010, 2015 and 2019. Patients who had undergone vasectomy and those who had a pH less than 5 or greater than 10 were excluded from this study. The following variables were assessed: ejaculate volume, sperm concentration, progressive motility, total progressively motile sperm count (TPMSC), total sperm count, and normal sperm morphology. Between 2010 and 2019, significant trends of decreasing values were observed in normal sperm morphology (- 50%), and the ejaculatory volume (- 7.4%), indicating a progressive deterioration of the values in both countries. In Nigeria, there were significant decreases in progressive motility (- 87%), TPMSC (- 78%), and sperm morphology (- 55%) between 2010 and 2019 (P < 0.001). Spearman`s rank correlation revealed significant negative associations between age and morphology (ρ =  - 0.24, P < 0.001), progressive motility (ρ =  - 0.31. P < 0.001), and TPMSC (ρ =  - 0.32, P < 0.001). Patients in South Africa were younger than those from Nigeria, with also a significantly higher sperm morphology, sperm concentration, progressive motility, total sperm count and TPMSC. Our findings provide a quantitative evidence of an alarming decreasing trend in semen parameters in Nigeria and South Africa from 2010 to 2019. It also proves that astheno- and teratozoospermia are the leading causes of male infertility in these regions. In addition to this, it also shows empirically that semen parameters decrease with advancement in age. These findings are the first report of temporal trends in semen parameters in Sub-Saharan countries, necessitating a thorough investigation on the underlying factors promoting this worrisome decline., (© 2023. The Author(s).)

Metal fume pollutants of urban Kano, a city of over 10 million people, and widespread metal works have increased exposure with related health effects. Few data on metal fume toxicity and atmospheric levels have been documented in Nigeria and Kano in particular. Hence, the work was aimed at evaluating the metal fume toxicity to laboratory rat species for setting the permissible limit of exposure in urban Kano. The investigation involved the collection of metal welding fumes and subsequent laboratory analysis. Experimental animals were then exposed intratracheally to varying doses of the fumes which were equivalent to normal metal workers' daily routine of 2, 4, and 8 h for 3, 5, 10, and 20 years. Following euthanization, whole blood samples were collected and functions of liver and delta-aminolevunilic acid dehydratase were evaluated in the serum. Exposure to the fumes has caused significant mortality that was observed to be dose-dependent and statistically different (p < 0.05); moreover, the fumes had synergistically affected the functions of liver. In addition, the fumes had increased (statistically) the activity delta-aminolevinilic acid dehydratase. This has indicated that exposure to metal welding fumes being multi-elemental is toxic and had produced mortality at exposure to higher doses of metal welding fumes. It was therefore established from the study that no-observed-adverse-effect level (NOAEL) for metal welding fumes is 25.73 mg with LD 50 of 270 mg which corresponds to the metal worker's 4-h shifts daily for 5 years under existing working conditions. It was recommended that regular monitoring should be put in place to limit exposure and extent of engagement in metal works beyond NOAEL levels., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Plasmodium falciparum (Pf) is the dominant malaria parasite in Nigeria though P. vivax (Pv), P. ovale (Po), and P. malariae (Pm) are also endemic. Blood samples (n = 31,234) were collected from children aged 0-14 years during a 2018 nationwide HIV survey and assayed for Plasmodium antigenemia, Plasmodium DNA, and IgG against Plasmodium MSP1-19 antigens. Of all children, 6.6% were estimated to have Pm infection and 1.4% Po infection with no Pv infections detected. The highest household wealth quintile was strongly protective against infection with Pm (aOR: 0.11, 95% CI: 0.05-0.22) or Po (aOR= 0.01, 0.00-0.10). Overall Pm seroprevalence was 34.2% (95% CI: 33.3-35.2) with lower estimates for Po (12.1%, 11.6-12.5) and Pv (6.3%, 6.0-6.7). Pm seropositivity was detected throughout the country with several local government areas showing >50% seroprevalence. Serological and DNA indicators show widespread exposure of Nigerian children to Pm with lower rates to Po and Pv., (© 2023. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Background: Cholera, a diarrheal disease caused by the bacterium Vibrio cholerae, transmitted through fecal contamination of water or food remains an ever-present risk in many countries, especially where water supply, sanitation, food safety, and hygiene are inadequate. A cholera outbreak was reported in Bauchi State, North-eastern Nigeria. We investigated the outbreak to determine the extent and assess risk factors associated with the outbreak., Methods: We conducted a descriptive analysis of suspected cholera cases to determine the fatality rate (CFR), attack rate (AR), and trends/patterns of the outbreak. We also conducted a 1:2 unmatched case-control study to assess risk factors amongst 110 confirmed cases and 220 uninfected individuals (controls). We defined a suspected case as any person > 5 years with acute watery diarrhea with/without vomiting; a confirmed case as any suspected case in which there was laboratory isolation of Vibrio cholerae O1 or O139 from the stool while control was any uninfected individual with close contact (same household) with a confirmed case. Children under 5 were not included in the case definition however, samples from this age group were collected where such symptoms had occurred and line-listed separately. Data were collected with an interviewer-administered questionnaire and analyzed using Epi-info and Microsoft excel for frequencies, proportions, bivariate and multivariate analysis at a 95% confidence interval., Results: A total of 9725 cases were line-listed with a CFR of 0.3% in the state. Dass LGA had the highest CFR (14.3%) while Bauchi LGA recorded the highest AR of 1,830 cases per 100,000 persons. Factors significantly associated with cholera infection were attending social gatherings (aOR = 2.04, 95% CI = 1.16-3.59) and drinking unsafe water (aOR = 1.74, 95% CI = 1.07-2.83)., Conclusion: Attending social gatherings and drinking unsafe water were risk factors for cholera infection. Public health actions included chlorination of wells and distribution of water guard (1% chlorine solution) bottles to households and public education on cholera prevention. We recommend the provision of safe drinking water by the government as well as improved sanitary and hygienic conditions for citizens of the state., (© 2023. The Author(s).)

Exposure to hydrocarbon products has been associated with numerous health risks and toxicities. Outdoor or indoor occupational exposure to highly volatile and lipid-soluble hydrocarbons has been linked to impairment of respiratory, cardiovascular, and liver functions. This study is aimed at determining the potential impact of occupational exposure to liquefied petroleum gas (LPG) in varying work environments. Respiratory symptoms, oxidative stress, cardio-pulmonary, and liver function parameters were assessed among LPG workers in the Kano metropolis, Nigeria. Study subjects were recruited from LPG filling stations and street LPG retail shops. Results of the study showed that the forced vital capacity (FVC) of LPG station workers was significantly lower (2.81 L/min; H = 22.473, p < 0.001) relative to the values recorded among LPG retail shop workers and the controls (3.54 L/min and 4.24 L/min respectively). A similar reduction was seen in the forced expiratory volume in the first second (FEV 1 ) and the forced expiratory flow in 25-75 % of forced vital capacity (FEF 25 - 75 ) obtained from the filling station workers (H = 32.722, p < 0.001 & H = 15.655, p <0.001 respectively). Furthermore, exposure to non-combusted LPG increased systolic blood pressure, mean arterial pressure, and serum liver enzymes. Findings from this study revealed that despite the high amount of coarse particulate matter in LPG retail shops, the filling station workers are more susceptible to the impairment of lung function possibly due to the high quantity of total volatile organic compounds (TVOCs) in the filling station environment., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: Coronavirus disease 2019 (COVID-19) has emerged as an important cause of morbidity and mortality worldwide. The aim of this study is to identify the clinical predictors of mortality among patients with COVID-19 pneumonia during first and second waves in a treatment center in northwestern Nigeria., Methods: This was a retrospective cohort study of 195 patients hospitalized with COVID-19 between April 2020 to March 2021 at a designated COVID-19 isolation center in Kano State, Northwest Nigeria. Data were summarized using frequencies and percentages. Unadjusted odds ratios and 95% confidence intervals and p-values were obtained. To determine independent determinants of mortality, we performed a stepwise multivariate logistic regression model., Results: Of 195 patients studied, 21(10.77%) patients died. Males comprised 158 (81.03%) of the study population. In the adjusted stepwise logistic regression analysis, age>64 years (OR = 9.476, 95% CI: 2.181-41.165), second wave of the pandemic (OR = 49.340, 95% CI:6.222-391.247), cardiac complications (OR = 24.984, 95% CI: 3.618-172.508), hypertension (OR = 5.831, 95% CI:1.413-24.065) and lowest systolic blood pressure while on admission greater than or equal to 90mmHg were independent predictors of mortality (OR = 0.111, 95%CI: 0.021-0.581)., Conclusion: Strategies targeted to prioritize needed care to patients with identified factors that predict mortality might improve patient outcome., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Dayyab et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Ectoparasites of dogs represent an important group of parasites. They often suck blood, cause pruritis, and could serve as vectors of many pathogens of veterinary and public health importance. In northeastern Nigeria, there is a lack of data regarding ectoparasites of dogs. Therefore, this study was undertaken to explore the external parasites of dogs and the associated epidemiological risk factors. A total of 1041 dogs (mean age = 8.5 ± 2.1 months) from residential house visit (54.9%) and those attending veterinary clinic (45.1%) were sampled in northeastern Nigeria. Multivariate logistic regression analysis assessed epidemiological risk factors associated with canine ectoparasitic infections. Of the 1041 dogs screened, 92.5% (963/1047) harbored one or more ectoparasites. Rhipicephalus sanguineus (52.4%), Linognathus setosus (7.8%), Ctenocephalides canis (2.3%), and Otodectes cynotis canis (1.4%) were the significantly encountered tick, lice, fleas, and mite species, respectively. Being female dog (OR = 1.8; p = 0.01), cross (OR = 2.2; p = 0.029), and exotic breeds (OR = 2.4; p = 0.02), < 7 months (OR = 3.1; p = 0.04) and 7-12 months (OR = 2.1; p = 0.01) aged dogs as well as rainy season (OR = 1.9; p = 0.02) were strong predictors for tick infestation. Similarly, cross (OR = 7.2; p = 0.001) and local breeds (OR = 2.8; p = 0.0001), dogs aged > 12 months (OR = 2.5; p = 0.03), and dogs used for hunting (OR = 3.2; p = 0.01) and as security guards (OR = 3.8; p = 0.01) were strongly associated with lice infestation. Results from this study revealed a high prevalence of external parasites parasitizing majority of the sampled dogs. Some of these parasites may serve as vectors of zoonotic pathogens posing public health risks., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

This study evaluated the perception of patent and proprietary medicine vendors (PPMVs) of the accreditation programme to improve their capacity to provide family planning (FP) services in Lagos and Kaduna, Nigeria. A cross-sectional mixed-method approach among 224 PPMVs was used to investigate their perception, willingness to pay for and adhere to the programme, its benefits, and the community women's perception of the value of PPMVs. Chi-square analysis and structural equation modelling (SEM) were used to analyse survey data, while focus group discussions (FGDs) were analysed using the grounded theory. PPMVs were enthusiastic because of the benefits, including increased clientele, revenue, and improved service provision capacity. Approximately 97% of PPMVs found the programme acceptable and were willing to pay, with 56% and 71% willing to pay between N5000-N14900 ($12-36) and N25000-N35000 ($60-87), respectively. A significant relationship between educational attainment, location, and willingness to pay was revealed. Among community women, the fear of side effects, lack of partners' support, myths and misconceptions, and lack of access to modern contraceptives were factors affecting contraceptive uptake. The capacity of PPMVs to improve FP uptake is promising and can be leveraged to improve health outcomes in communities while strengthening their businesses.

Background and Aims: The global prevalence of diabetes mellitus is on the increase, and Africa, particularly Nigeria is not left out. The management of the disease using a diabetes drug is often a hard choice to make for many. Information on the right food is inevitably important, as eating some type of food and avoiding or limiting some could help manage diabetes. Therefore, this study investigated glycemic indices of commonly consumed staples in Nigeria., Methods: Databases like PubMed, ScienceDirect, Google scholars, African journal online and Nigerian journal online was used to search for relevant information. Keywords like: nutritional management, diabetes in Nigeria, quality of life, prevalence, glycemic index, foods and diabetes, macronutrients and diabetes, were used separately or combined to obtain the relevant information., Results: Findings from literature search revealed that the glycemic indices of many staples such as Rice dough (Tuwo shinkafa), maize dough (tuwo masara), millet dough (tuwo gero), yam/cassava flour (amala), pounded fermented cassava (fufu, akpu), garri (eba), african salad (abacha), pounded yam (ema, iyan), rice (shinkafa, isesi), beans (wake, ewa, Agwa), and plantain (Ojoko, Ogbagba, Ogede) that are consumed in different parts of Nigeria are high (75.0%-97.0%). However, available information revealed that less commonly consumed foods like, Maize pudding (igbangwu), dried beef floss (dambu), Fonio (acha), bean pudding (moi-moi) and Tom Brownvita (Turnbrown) exhibit lower glycemic indices (14.1%-52.9%)., Conclusions: This study revealed the few among several local foods in Nigeria that are low in glycemic indices that could be useful in the management of Type-2 diabetes. However, these foods may require further certification by appropriate authorities and agencies to enable persons with diabetes, particularly in Nigeria make informed choices on the right food to consume., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2022 Research Trust of DiabetesIndia (DiabetesIndia) and National Diabetes Obesity and Cholesterol Foundation (N-DOC). Published by Elsevier Ltd. All rights reserved.)

Objectives: Non-disclosure of positive HIV status in population-based surveys causes underestimation of national HIV diagnosis and biases inferences about engagement in the care continuum. This study investigated individual and household factors associated with HIV non-disclosure to survey interviewers in Nigeria., Design: Secondary analysis of a cross sectional population-based household HIV survey., Methods: We analyzed data from adults aged 15-64 years who tested positive for HIV and had antiretroviral drugs (ARVs) in their blood from a nationally representative HIV sero-survey conducted in Nigeria in 2018. We considered ARV use as a proxy for knowledge of HIV diagnosis; thus, respondents who self-reported to be unaware of their HIV status were classified as non-disclosers. We estimated the associations between non-disclosure and various sociodemographic, clinical, and household characteristics using weighted logistic regression., Results: Among 1266 respondents living with HIV who were taking ARVs, 503 (40%) did not disclose their HIV status to interviewers. In multivariable statistical analyses, the adjusted odds of non-disclosure were highest among respondents aged 15-24 years, those with less than a primary school education, and those who were the only person living with HIV in their household., Conclusions: Non-disclosure of positive HIV status to survey personnel is common among adults who are receiving treatment in Nigeria. These findings highlight the importance of validating self-reported HIV status in surveys using biomarkers of ARV use. Meanwhile, it is crucial to improve disclosure by strengthening interview procedures and tailoring strategies towards groups that are disproportionately likely to underreport HIV diagnoses., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: HIV transmission can occur with a viral load of at least 200 copies per mL of blood and low-level viraemia can lead to virological failure; the threshold level at which risk for virological failure is conferred is uncertain. To better understand low-level viraemia prevalence and outcomes, we analysed retrospective longitudinal data from a large cohort of people living with HIV on antiretroviral therapy (ART) in Nigeria., Methods: In this retrospective cohort study using previously collected longitudinal patient data, we estimated rates of virological suppression (≤50 copies per mL), low-level viraemia (51-999 copies per mL), virological non-suppression (≥1000 copies per mL), and virological failure (≥2 consecutive virological non-suppression results) among people living with HIV aged 18 years and older who initiated and received at least 24 weeks of ART at 1005 facilities in 18 Nigerian states. We analysed risk for low-level viraemia, virological non-suppression, and virological failure using log-binomial regression and mixed-effects logistic regression., Findings: At first viral load for 402 668 patients during 2016-21, low-level viraemia was present in 64 480 (16·0%) individuals and virological non-suppression occurred in 46 051 (11·4%) individuals. Patients with low-level viraemia had increased risk of virological failure (adjusted relative risk 2·20, 95% CI 1·98-2·43; p<0·0001). Compared with patients with virological suppression, patients with low-level viraemia, even at 51-199 copies per mL, had increased odds of low-level viraemia and virological non-suppression at next viral load; patients on optimised ART (ie, integrase strand transfer inhibitors) had lower odds than those on non-integrase strand transfer inhibitors for the same low-level viraemia range (eg, viral load ≥1000 copies per mL following viral load 400-999 copies per mL, integrase strand transfer inhibitor: odds ratio 1·96, 95% CI 1·79-2·13; p<0·0001; non-integrase strand transfer inhibitor: 3·21, 2·90-3·55; p<0·0001)., Interpretation: Patients with low-level viraemia had increased risk of virological non-suppression and failure. Programmes should revise monitoring benchmarks and targets from less than 1000 copies per mL to less than 50 copies per mL to strengthen clinical outcomes and track progress to epidemic control., Funding: None., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Nigeria had a confirmed case of COVID-19 on February 28, 2020. On March 17, 2020, the Nigerian Government inaugurated the Presidential Task Force (PTF) on COVID-19 to coordinate the country's multisectoral intergovernmental response. The PTF developed the National COVID-19 Multisectoral Pandemic Response Plan as the blueprint for implementing the response plans. The PTF provided funding, coordination, and governance for the public health response and executed resource mobilization and social welfare support, establishing the framework for containment measures and economic reopening. Despite the challenges of a weak healthcare infrastructure, staff shortages, logistic issues, commodity shortages, currency devaluation, and varying state government cooperation, high-level multisectoral PTF coordination contributed to minimizing the effects of the pandemic through early implementation of mitigation efforts, supported by a strong collaborative partnership with bilateral, multilateral, and private-sector organizations. We describe the lessons learned from the PTF COVID-19 for future multisectoral public health response.

Objective: HIV and tuberculosis (TB) are risk factors for non-communicable chronic lung disease (CLD). Despite the high prevalence of these infections in West Africa, there are no studies that compare CLD between people with HIV and HIV-negative populations in this setting. This study sought to quantify the contribution of HIV and TB infection in addition to conventional CLD risk factors, such as tobacco and biofuel exposure, to CLD in urban West Africa., Design: A multi-centre cross-sectional study was conducted in three community clinics in Lagos, Nigeria between 2018 and 2019., Methods: Spirometry, questionnaires and clinical records were used to estimate prevalence of CLD and association with risk factors., Results: In total, 148 HIV-negative individuals and 170 HIV-positive individuals completed the study. Current cigarette (11 of 318, 3.5%) and lifetime domestic biofuel (6 of 318, 1.8%) exposures were low. Airway obstruction (33 of 170, 19.4% vs. 12 of 148, 8.1%, P  = 0.004) and CLD (73 of 170, 42.9% vs. 34 of 148, 23%, P  < 0.0001) were more prevalent in people with HIV compared with the HIV-negative group. HIV infection [odds ratio 2.35 (1.33, 4.17), P  = 0.003] and history of TB [odds ratio 2.09 (1.04, 4.20), P  = 0.038] were independently associated with increased risk of CLD., Conclusion: HIV and TB far outweigh conventional risk factors, including tobacco and domestic biofuel exposure, as drivers of non-communicable CLD in urban West Africa. Current global policy for CLD may have limited impact on CLD in this setting. Enhanced prevention, diagnosis and management strategies for incident HIV and TB infections are likely to have a significant impact on long-term lung health in sub-Saharan Africa., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Nigeria has the fourth largest burden of HIV globally. Key populations, including female sex workers, men who have sex with men, and people who inject drugs, are more vulnerable to HIV than the general population due to stigmatized and criminalized behaviors. Reliable key population size estimates are needed to guide HIV epidemic response efforts., Objective: The objective of our study was to use empirical methods for sampling and analysis to improve the quality of population size estimates of female sex workers, men who have sex with men, and people who inject drugs in 7 states (Akwa Ibom, Benue, Cross River, Lagos, Nasarawa, Rivers, and the Federal Capital Territory) of Nigeria for program planning and to demonstrate improved statistical estimation methods., Methods: From October to December 2018, we used 3-source capture-recapture to produce population size estimates in 7 states in Nigeria. Hotspots were mapped before 3-source capture-recapture started. We sampled female sex workers, men who have sex with men, and people who inject drugs during 3 independent captures about one week apart. During hotspot encounters, key population members were offered inexpensive, memorable objects unique to each capture round. In subsequent rounds, key population members were offered an object and asked to identify objects received during previous rounds (if any). Correct responses were tallied and recorded on tablets. Data were aggregated by key population and state for analysis. Median population size estimates were derived using Bayesian nonparametric latent-class models with 80% highest density intervals., Results: Overall, we sampled approximately 310,000 persons at 9015 hotspots during 3 independent captures. Population size estimates for female sex workers ranged from 14,500 to 64,300; population size estimates for men who have sex with men ranged from 3200 to 41,400; and population size estimates for people who inject drugs ranged from 3400 to 30,400., Conclusions: This was the first implementation of these 3-source capture-recapture methods in Nigeria. Our population size estimates were larger than previously documented for each key population in all states. The Bayesian models account for factors, such as social visibility, that influence heterogeneous capture probabilities, resulting in more reliable population size estimates. The larger population size estimates suggest a need for programmatic scale-up to reach these populations, which are at highest risk for HIV., (©Anne F McIntyre, Andrew Mitchell, Kristen A Stafford, Samuel Uchenna Nwafor, Julia Lo, Victor Sebastian, Amee Schwitters, Mahesh Swaminathan, Ibrahim Dalhatu, Man Charurat. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 26.10.2022.)

Objectives: Nigeria reported an upsurge in cholera cases in October 2020, which then transitioned into a large, disseminated epidemic for most of 2021. This study aimed to describe the epidemiology, diagnostic performance of rapid diagnostic test (RDT) kits and the factors associated with mortality during the epidemic., Design: A retrospective analysis of national surveillance data., Setting: 33 of 37 states (including the Federal Capital Territory) in Nigeria., Participants: Persons who met cholera case definition (a person of any age with acute watery diarrhoea, with or without vomiting) between October 2020 and October 2021 within the Nigeria Centre for Disease Control surveillance data., Outcome Measures: Attack rate (AR; per 100 000 persons), case fatality rate (CFR; %) and accuracy of RDT performance compared with culture using area under the receiver operating characteristic curve (AUROC). Additionally, individual factors associated with cholera deaths and hospitalisation were presented as adjusted OR with 95% CIs., Results: Overall, 93 598 cholera cases and 3298 deaths (CFR: 3.5%) were reported across 33 of 37 states in Nigeria within the study period. The proportions of cholera cases were higher in men aged 5-14 years and women aged 25-44 years. The overall AR was 46.5 per 100 000 persons. The North-West region recorded the highest AR with 102 per 100 000. Older age, male gender, residency in the North-Central region and severe dehydration significantly increased the odds of cholera deaths. The cholera RDT had excellent diagnostic accuracy (AUROC=0.91; 95% CI 0.87 to 0.96)., Conclusions: Cholera remains a serious public health threat in Nigeria with a high mortality rate. Thus, we recommend making RDT kits more widely accessible for improved surveillance and prompt case management across the country., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Foot-and-mouth disease (FMD) affects the livestock industry and socioeconomic sustainability of many African countries. The success of FMD control programs in Africa depends largely on understanding the dynamics of FMD virus (FMDV) spread. In light of the recent outbreaks of FMD that affected the North-Western African countries in 2018 and 2019, we investigated the evolutionary phylodynamics of the causative serotype O viral strains all belonging to the East-Africa 3 topotype (O/EA-3). We analyzed a total of 489 sequences encoding the FMDV VP1 genome region generated from samples collected from 25 African and Western Asian countries between 1974 and 2019. Using Bayesian evolutionary models on genomic and epidemiological data, we inferred the routes of introduction and migration of the FMDV O/EA-3 topotype at the inter-regional scale. We inferred a mean substitution rate of 6.64 × 10 -3  nt/site/year and we predicted that the most recent common ancestor for our panel of samples circulated between February 1967 and November 1973 in Yemen, likely reflecting the epidemiological situation in under sampled cattle-exporting East African countries. Our study also reinforces the role previously described of Sudan and South Sudan as a frequent source of FMDVs spread. In particular, we identified two transboundary routes of O/EA-3 diffusion: the first from Sudan to North-East Africa, and from the latter into Israel and Palestine AT; a second from Sudan to Nigeria, Cameroon, and from there to further into West and North-West Africa. This study highlights the necessity to reinforce surveillance at an inter-regional scale in Africa and Western Asia, in particular along the identified migration routes for the implementation of efficient control measures in the fight against FMD., (© 2022 The Authors. Transboundary and Emerging Diseases published by Wiley-VCH GmbH.)

Background: Data on awareness of HIV status among people living with HIV (PLHIV) are critical to estimating progress toward epidemic control. To ascertain the accuracy of self-reported HIV status and antiretroviral drug (ARV) use in the Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS), we compared self-reported HIV status with HIV rapid diagnostic test (RDT) results and self-reported ARV use with detectable blood ARV levels., Methods: On the basis of responses and test results, participants were categorized by HIV status and ARV use. Self-reported HIV status and ARV use performance characteristics were determined by estimating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Proportions and other analyses were weighted to account for complex survey design., Results: During NAIIS, 186,405 participants consented for interview out of which 58,646 reported knowing their HIV status. Of the 959 (weighted, 1.5%) who self-reported being HIV-positive, 849 (92.1%) tested HIV positive and 64 (7.9%) tested HIV negative via RDT and polymerase chain reaction test for discordant positive results. Of the 849 who tested HIV positive, 743 (89.8%) reported using ARV and 72 (10.2%) reported not using ARV. Of 57,687 who self-reported being HIV negative, 686 (1.2%) tested HIV positive via RDT, with ARV biomarkers detected among 195 (25.1%). ARV was detected among 94.5% of those who self-reported using ARV and among 42.0% of those who self-reported not using ARV. Overall, self-reported HIV status had sensitivity of 52.7% (95% confidence interval [CI]: 49.4%-56.0%) with specificity of 99.9% (95% CI: 99.8%-99.9%). Self-reported ARV use had sensitivity of 95.2% (95% CI: 93.6%-96.7%) and specificity of 54.5% (95% CI: 48.8%-70.7%)., Conclusions: Self-reported HIV status and ARV use screening tests were found to be low-validity measures during NAIIS. Laboratory tests to confirm self-reported information may be necessary to determine accurate HIV and clinical status for HIV studies in Nigeria., Competing Interests: The authors have no conflicts of interest to disclose.

Rabies is an endemic, highly fatal, and vaccine-preventable disease with severe socio-economic implications. Most (99%) human rabies cases are transmitted through dog bites. Children under 15 years account for 40% of all dog bite victims and 35-50% of all rabies deaths. Rabies awareness among this vulnerable group is critical to rabies prevention. However, there is a paucity of data on rabies awareness among pupils under 15. Hence, this study assessed the awareness and attitude of pupils under 15 years towards canine rabies in Kwara state in Nigeria. The study was conducted as a cross-sectional survey of 1,388 pupils across the state using a structured questionnaire that was administered as a one-on-one interview using the Open Data Kit on Android phones in December 2019. Of the 1388 pupils included in this study, only 21.7% (n = 301) of them were aware of rabies. The mean rabies score was 1.7±0.8 and only 29.2% (n = 88/301) of the pupils had adequate knowledge of canine rabies. The dog ownership rate was 18.7% (n = 259) with an average of 1.93 dogs per household. Approximately 5% (n = 66) of the pupils have been previously bitten by a dog. One-third of the dog bite victims (35%, n = 23/66) were managed and treated at home and only 12% (n = 8/66) were treated in a health facility. The result of the multivariable logistic regression showed that students aged between 13-15 years were more likely (OR: 1.93; 95% CI: 0.72-3.01; p < 0.001) to have adequate knowledge of rabies than the younger pupils. Similarly, pupils that have dogs in their households (OR: 2.09; 95%CI: 1.49-2.75; p < 0.001) and those that reside in Kwara South (OR:1.78 95% CI:1.29, 2.44; p < 0.001) were more likely to be aware and have adequate knowledge of canine rabies respectively. Finally, Pupils from non-dog-owning households were more likely (OR:2.2; 95% CI: 1.45, 4.42; p < 0.001) to have been bitten by dogs than those from dog-owning households. The awareness and attitude of pupils under 15 to canine rabies was poor. We advocate the introduction of rabies lessons into the school curriculum in Kwara State to reduce the incidence of dog bites and prevent dog-mediated human rabies., Competing Interests: The authors have declared that no competing interests exist.