Search

Introduction: Annual outbreak of Lassa Fever (LF) has been reported in Ondo State over the years. We analyzed LF surveillance data from January 2014 to December 2019 to describe the epidemiological pattern of the outbreak. Method: Lassa fever dataset from January 2014 to December 2019 was obtained from the State Ministry of Health. Variables analyzed include date of onset of symptom, age, gender, place (Local Government Area, LGA) and outcome of laboratory test. Data were summarized using frequencies, proportions, chart and maps. Results: From January 2014 and December 2019, 2141 suspected LF cases were reported. Of these, 551 cases were laboratory confirmed with 134 deaths recorded. The LF cases (suspected vs. confirmed) reported increased in 2016 (73 vs. 19), 2017 (207 vs. 76), 2018 (452 vs. 159) and 2019 (856 vs. 285) respectively. Most of the confirmed cases (89.5%) were ≥15 years while more than half (53.7%) were males. Prior to 2016, only two LGAs (Owo and Ose) recorded continued transmission of the disease. However, between 2016 and 2019, the disease had spread to 8 neighboring LGAs (P < 0.001) with the CFR declining from 67% in 2015 to 20% in 2019. Conclusion: We found an unusual increase in the suspected LF cases reported between January 2016 and December 2019 with a corresponding increase in the confirmed cases and high annual case fatality rates. Hence, we recommend intensified surveillance activities to enhance timely reporting of cases and laboratory confirmation to ensure early commencement of treatment to reduce the case fatality rate.

Background: Secondary transmission of Lassa fever has been recorded annually among healthcare workers who provided care. An outbreak of the disease in Ondo State, Southwest Nigeria in 2018, recorded high morbidity and mortality. This study was conducted to assess the knowledge, risk perception, and preventive practices towards Lassa fever among healthcare workers. Methods: A health facility-based descriptive cross-sectional study design was conducted involving senior members of staff randomly selected from the list of staff members. A structured pre-tested questionnaire was administered to 554 consenting respondents in 304 health facilities. Results: More than half of the respondents (317, 57.2%) are health workers in primary healthcare cadres. Although 444 (80.1%) knew the case definition for reporting, only 379 (68.4%) correctly indicated the reporting channel. Concerning risk perception, 174 (31.4%) rated their risk of contracting the disease in the workplace as high, and 309 (55.8%) indicated that hospitals' infection control policy is inadequate. Furthermore, only 76 (13.7%) of the respondents reported having modified their working habits for fear of being infected with Lassa fever three months before the study with 368 (66.4%) and 474 (85.6%) reported that they always use aprons and gloves respectively during treatment of patients. Conclusion: There is a need to strengthen the hospital infection control policy and train healthcare workers on reporting suspected cases.

ObjectiveThis study employed the Consolidated Framework for Implementation Research (CFIR) to assess factors that enhanced or impeded the implementation of community engagement strategies using the Nigerian polio programme as a point of reference.DesignThis study was a part of a larger descriptive cross-sectional survey. The CFIR was used to design the instrument which was administered through face-to-face and phone interviews as well as a web-based data collection platform, Qualtrics.SettingThe study took place in at least one State from each of the six geopolitical zones in Nigeria (Nasarawa, Borno, Kano, Sokoto, Anambra, Bayelsa, Lagos, Ondo and Oyo States as well as the Federal Capital Territory).ParticipantsThe respondents included programme managers, policy-makers, researchers and frontline field implementers affiliated with the Global Polio Eradication Initiative (PEI) core partner organisations, the three tiers of the government health parastatals (local, state and federal levels) and academic/research institutions.ResultsData for this study were obtained from 364 respondents who reported participation in community engagement activities in Nigeria’s PEI. Majority (68.4%) had less than 10 years’ experience in PEI, 57.4% were involved at the local government level and 46.9% were team supervisors. Almost half (45.0%) of the participants identified the process of conducting the PEI program and social environment (56.0%) as the most important internal and external contributor to implementing community engagement activities in the community, respectively. The economic environment (35.7%) was the most frequently reported challenge among the external challenges to implementing community engagement activities.ConclusionCommunity engagement strategies were largely affected by the factors relating to the process of conducting the polio programme, the economic environment and the social context. Therefore, community engagement implementers should focus on these key areas and channel resources to reduce obstacles to achieve community engagement goals.

Aims: To assess the knowledge and perception about micronutrient powder (MNP) use, compliance with use of the product, and determine factors influencing compliance to continual use of MNP for food fortification among caregivers of children aged 6-23 months in Konduga LGA, Borno State, Nigeria. Study Design: A cross-sectional study was conducted. Place and Duration of Study: The study was conducted in Konduga LGA, Borno State Nigeria in August 2018. Methodology: A total of 218 caregivers of children aged 6-23 months were selected using a multistage sampling technique. A semi-structured interviewer-administered questionnaire was used to interview respondents on socio-demographic characteristics, knowledge about complementary feeding, perception about MNP use and compliance with use of MNP for food fortification. Data were analyzed using descriptive statistics, Chi-square test and logistic regression, with the level of significance set at 0.05. Results: Respondents were female with 111 (50.9%) below 30 years of age (mean age: 29.3±8.0). Twenty-four (11%) of the respondents have good knowledge of complementary feeding and 77 (35.3%) have a good perception of the use of MNP. Almost two-thirds [135 (61.9%)] of the respondents used MNP. Factors that influenced respondents’ compliance with use of MNP include; being

Background The year 2014 was a turning point for polio eradication in Nigeria. Confronted with the challenges of increased numbers of polio cases detected in rural, hard-to-reach (HTR), and security-compromised areas of northern Nigeria, the Nigeria polio program introduced the HTR project in four northern states to provide immunization and maternal and child health services in these communities. The project was set up to improve population immunity, increase oral polio vaccine (OPV) and other immunization uptake, and to support Nigeria’s efforts to interrupt polio transmission by 2015. Furthermore, the project also aimed to create demand for these services which were often unavailable in the HTR areas. To this end, the program developed a community engagement (CE) strategy to create awareness about the services being provided by the project. The term HTR is operationally defined as geographically difficult terrain, with any of the following criteria: having inter-ward/inter-Local Government Area/interstate borders, scattered households, nomadic population, or waterlogged/riverine area, with no easy to access to healthcare facilities and insecurity. Methods We evaluated the outcome of CE activities in Kano, Bauchi, Borno, and Yobe states to examine the methods and processes that helped to increase OPV and third pentavalent (penta3) immunization coverage in areas of implementation. We also assessed the number of community engagers who mobilized caregivers to vaccination posts and the service satisfaction for the performance of the community engagers. Results Penta3 coverage was at 22% in the first quarter of project implementation and increased to 62% by the fourth quarter of project implementation. OPV coverage also increased from 54% in the first quarter to 76% in the last quarter of the 1-year project implementation. Conclusions The systematic implementation of a CE strategy that focused on planning and working with community structures and community engagers in immunization activities assisted in increasing OPV and penta3 immunization coverage.

A vaccine-derived poliovirus (VDPV) was isolated in an acute flaccid paralysis (AFP) case reported from Ile-Ife, in Osun state, Southwest Nigeria. We investigated the epidemiological characteristics of the polio event and described the immediate public health response that followed. We interviewed the primary caregiver of the case and conducted active case searches for additional AFP cases in the communities in Ife East Local Government Area (LGA) of Osun state. Stool samples of contacts and non-contacts were collected and sent for laboratory investigation. A public health response with mass supplementary immunization in the affected areas followed immediately in the ward the case was located in October 2015. Also, we reviewed the administrative record of the oral polio vaccine (OPV) coverage in the LGA in the previous four years. The VDPV case was a female, one-month-old child with adequate vaccination history for her age. However, the environment of the child was relatively filthy with inappropriate facilities. Laboratory reports from contact samples were negative for VDPV or any polio isolates. A missed AFP case was found from active case searches and a high proportion of under-five children was immunized with tOPV. The OPV3 administrative coverage in the LGA peaked in 2014 (103%) and dropped in 2015 (67%). Efforts directed toward improving environmental hygiene in households and improving OPV coverage in subsequent routine and supplementary immunization are suggested.

Background: Ondo state recorded its last case of indigenous Wild Polio Virus in 2008 and its last Polio compatible case in 2010. Poliovirus transmission was interrupted through adherence to the guidelines of the World Health Organization (WHO), among which is Acute Flaccid Paralysis (AFP) surveillance. We aimed to describe the state’s Polio surveillance performance for the past five years, 2016-2020, using WHO recommended indicators and identified gaps for improvement.Methods: A retrospective review of records was conducted using AFP case-based surveillance data between January 2016 to December 2020. Data analysis was carried out using Microsoft Excel and mapping was done using Quantum Geographic Information System (GIS).Results: A total of 1,096 AFP cases were reported from 2016 to 2020, of which none was confirmed as Poliomyelitis. Children

Background: Acute gastroenteritis, a very common disease in humans affecting both children and adults, remains a major public health concern worldwide. Several groups of viruses have been reported as the causative agents of acute gastroenteritis. An outbreak of acute gastroenteritis with a high fatality rate was reported in Ondo State, Southwest, Nigeria, in September 2020. Methods: To provide a descriptive epidemiology of the outbreak, a field investigation was carried out in affected communities in September 2020. Results: Four Local Government Areas (LGA) were affected, with Odigbo LGA having the highest attack rate of 14.9 per 100,000 population. The epidemic curve was propagated in nature. 50 cases were reported with 21 deaths (42%). The outbreak primarily affected 15-year-olds (94%, n=47) and more males (58%, n=29). Conclusion: Poor sanitation, food, and water hygiene conditions in communities of the LGA visited were observed. The spread of the outbreak was probably facilitated by water sellers.

Background The occurrence of adverse events following immunization (AEFI) in national immunization programmes is very rare; however, if they occur causality assessment is conducted to identify the associated cause. In the report, we describe a case of severe necrotizing fasciitis in the left arm of a 9-month old boy following administration of the measles vaccine. Case presentation A 9-month old boy presented with swelling on the left upper arm and adjoining the chest area, low-grade continuous fever, frequent passage of loose watery stool and persistent cries 24 h after measles vaccine was administered on the left upper arm. On examination, he was mildly pale, febrile, anicteric. Extensive erythema of the left upper arm occurred thereafter with extensive scalded skin lesions involving the deltoid area, the upper chest wall and arm. This was followed by desquamation of the affected areas and severe necrosis. A diagnosis of severe necrotizing fasciitis was made. A causality assessment was conducted by the state AEFI committee using the detailed AEFI investigation forms to identify the cause of the incidence. Conclusion Here we present a rare case of necrotizing fasciitis which could have been caused by incorrect use of reconstituted measles vaccine. Hence we recommend training of routine immunization service providers on proper vaccine management as well as intensified supervision of immunization sessions.

We describe the use of single-shot lamina thoracic paravertebral block (TPVB) with sedation for a 56-year-old female patient who had modified radical mastectomy with axillary clearance. Two years ago, she suffered vocal cord palsy post thyroidectomy, which was managed with tracheostomy. The tracheostomy tube was removed 8 months later, leaving the patient with persistent hoarseness of voice and left vocal cord palsy. She declined general anesthesia and consented for TPVB. The surgery lasted 95 minutes and was successfully completed with TPVB. Her vital signs were stable during the operation. She had low pain scores, minimal opioid use, early alimentation, and no postoperative nausea and vomiting and was discharged early. We present the anesthetic management of this case in our setting, where TPVB under ultrasound guidance and modern drug-delivery systems for sedation are unavailable.

Objective: This study determined the effect of adherence to highly active antiretroviral therapy (HAART) on body mass index (BMI) and immunological and virological parameters of people living with HIV/AIDS (PLWHA) attending University College Hospital, Ibadan.Methodology: Prospective cohort of consenting PLWHA was followed up for a minimum of 3 months, had their drug adherence determined using pharmacy records and self-reporting. The sociodemographic data, weight, height, plasma viral load and CD4 count were recorded at baseline and 3 months. These data were entered into the computer and analyzed.Results: A total of 318 PLWHA with a median age of 38 ±9.6 years participated. Fifty-four percent were female. Sixty-three percent were 95% adherent to HAART. Most (99.4%) were on nonnucleoside reverse transcriptase inhibitor-based therapy. There was a remarkable fall in viral load to non-detectable levels among adherent compared with non-adherent PLWHA. Furthermore, there was a significant increase in CD4 count among adherent compared with non-adherent PLWHA. Adherent clients showed marked improvement in BMI and immunological and virological status.Conclusion: Adherence to HAART reduced viral load to an undetectable level and increased CD4 count among adherent PLWHA on HAART.Keywords: HAART adherence; CD4 count; Viral load; PLWHA; Nigeria

Background: Nutrition is an important element of a child’s survival and development. To achieve MDG 4 in Nigeria, nutritional status of under-five children needs to be improved as malnutrition remains an underlying factor in about one third of under-five deaths in Nigeria. Unfortunately, along with high prevalence of malnutrition, urban-rural disparities persist in child nutritional outcomes in Nigeria. Objective: To determine the differences in and predictors of the nutritional status of children in urban and rural areas of Akinyele LGA, Ibadan. Methods: A community based comparative cross sectional study was carried out in one urban and one rural ward of Akinyele LGA. Data was collected from mothers of 614 children. Anthropometric measurements were obtained from the children and Z scores generated using the WHO standard population. The children were classified as stunted, wasted or underweight using a cut off of -2 SD

Introduction: An outbreak of Lassa Fever (LF) reported and confirmed in Ondo state, Southwest Nigeria in January 2016 was investigated. This paper provides the epidemiology of the LF and lessons learnt from the investigation of the outbreak. Methods: The incidence management system (IMS) model was used for the outbreak coordination. Cases and deaths were identified through the routine surveillance system using standard definitions for suspected and confirmed cases and deaths respectively. Blood specimens collected from suspect cases were sent for confirmation at a WHO accredited laboratory. Active case search was intensified, and identified contacts of confirmed cases were followed up for the maximum incubation period of the disease. Other public health responses included infection prevention and control, communication and advocacy as well as case management. Data collected were analysed using SPSS 20, by time, place and persons and important lessons drawn were discussed. Results: We identified 90 suspected LF cases of which 19 were confirmed by the laboratory. More than half (52.6%) of the confirmed cases were females with majority (73.7%) in the age group ≥ 15 years. The Case Fatality Rate (CFR) of 63.2% among the laboratory-confirmed positive cases where 9 of 19 cases died, was significantly higher compared to the laboratory confirmed negative cases where 6 of the 65 cases died ( CFR; 8.5%) p ≤ 0.05. Two hundred and eighty-seven contacts of the confirmed cases were identified, out of which 267(93.0%) completed the follow-up without developing any symptoms and 2 (0.7%) developed symptoms consistent with LF and were confirmed by the laboratory. More than half of the contacts were females (64.5%) with most of them (89.2%) in the age group ≥ 25 years. Discussion: One key lesson learnt from the investigation was that the confirmed cases were mainly primary cases; hence the needs to focus on measures of breaking the chain of transmission in the animal-man interphase during Lassa fever epidemic preparedness and response. In addition, the high case fatality rate despite early reporting and investigation suggested the need for a review of the case management policy and structure in the State. Key Words: Lassa fever, Outbreak Response, Incident Management System, Nigeria

Vaccine preventable diseases (VPDs) are a leading course of child under-five mortality in sub-Saharan Africa. A target of 95% immunization coverage is necessary for the sustained control of VPDs. This study aims to determine the immunization status and its associated demo-graphic factors among children 12-59 months old in Akinyele Local Government area (LGA), Oyo State, Nigeria. A community-based cross-sectional study was carried out in one urban and one rural ward of Akinyele LGA. Fourhundred and forty-four (449) Under-five children were selected by multistage sampling technique. Data were collected from caregivers using interviewer administered questionnaires. Odds ratios at 95% CIand Chi square at 5% significant level were computed to identify the factors associated with non or partial immunisation. Multiple logistics regression at 5% significance level was done to determine the socio-demographic determinants of immunisation status. Overall, 449 children aged 12-59 months were surveyed of which 213(47.4%) were males and 236(52.6%) were from urban area. Overall, 365(81.3%) was fully immunized, 75(16.7%) was partially immunized and 9(2.0%) had never been immunized. Predictors of a child being partially or un-immunised were being in the fourth wealth quintile (AOR 7.9; 95%CI: 2.7-18.0), poorest wealth quintile (AOR 14.5; 95%CI 4.2-20.5), having a mother with no education (AOR 6.4; 95%CI: 2.9-14.1) and a mother that practiced Islam (AOR: 2.2; 95%CI: 1.3-3.7). Immunisation coverage was somewhat high but still suboptimal among the study population. Strategies that improve female literacy and those that target religious institutions may be effective in improving immunisation uptake.

An outbreak of measles occurred in Olorunda district, Nigeria, between January and June 2013. Outbreak response immunisation (ORI) was conducted as a control measure. We will describe the epidemiology of the outbreak and assess the impact of ORI. We visited all of the health facilities (73) in July 2013 to ascertain the cases through a review of the patient registers and case notes, using the World Health Organization case definition of measles. Data on children vaccinated during ORI were retrieved. To assess the impact of ORI, cumulative measles incidence for the targeted age group (6-59 months) and non-target age group (< 6 months and ≥ 5 years) was calculated before and after ORI. A total of 94 cases were identified, of which 89% were confirmed by laboratory and epidemiological linkage. More than three quarters (80%) of the confirmed cases were children < 5 years, with a 2% case fatality rate. The outbreak spanned 26 weeks, reaching its peak in week 12. Cases were clustered in the Sabo and Ota Efun wards, with over 88% of the confirmed cases having a zero-dose measles vaccination history. A total of 2 861 children were vaccinated during ORI, with administrative coverage of 10%. The cumulative incidence in the target age prior to ORI was 153.8 per 100 000, which decreased to 27.9 per 100 000 after ORI. The incidence in the non-target age group also decreased from 11.1 per 100 000 before ORI to 2.2 per 100 000 after ORI. Our investigation shows that ORI was effective in the control of the measles outbreak in Olorunda district. Hence, there is need to strengthen the conduct of ORI exercises during a measles outbreak to achieve higher coverage.

While outbreaks of infectious diseases have long presented a public health challenge, especially in developing countries like Nigeria; within recent years, the frequency of such outbreaks has risen tremendously. Furthermore, with the recent outbreaks of emerging and re-emerging infectious diseases such as Ebola virus disease and other epidemic prone diseases in Nigeria demanding immediate public health action, there is a need to strengthen the existing notifiable disease surveillance and notification system with increased clinicians' involvement in timely reporting of notifiable diseases to designated public health authorities for prompt public health action. Hence, this paper provides the opportunity to increase awareness among clinicians on the importance of immediate reporting of notifiable diseases and intensify engagement of clinicians in disease notification activities by describing various notifiable diseases in Nigeria using their surveillance case definition, outlines the reporting channel for notifying these diseases and highlights the roles of clinicians in the current disease surveillance and notification network for early disease outbreak detection and public health response in Nigeria.

Background With the establishment of a new medical college in Botswana to train generalist-doctors and specialists, we set out to explore the career preferences of medical students, factors that influence their choices and attitude to local postgraduate training. Methods A descriptive cross-sectional questionnaire-based study was conducted among medical students in their third to fifth year, at the Faculty of Medicine, University of Botswana. The structured, self-administered questionnaires which were hand-delivered covered demographic characteristics of responders, career choices, preferred location of specialisation and factors that influenced the choices. Results Of the 143 medical students approached, 116 (81.0%) returned completed questionnaires. Of the responders, 102 (87.9%) intend to pursue postgraduate specialisation against 2 (1.7%) who declined; 12 (10.3%) were undecided. The four most preferred specialties which constituted 68.1% were surgery (28.4%), paediatrics (19.0%), internal medicine (12.9%), obstetrics and gynaecology (7.2%). There was male preference for surgery (p = 0.04), while women were drawn more towards paediatrics and psychiatry (p = 0.04 and p = 0.01, respectively). Personal interest and aptitude was considered the most important factor among most responders (46.2%), followed by enjoyment of the posting (19.8%). A high proportion of responders 80 (69.0%) preferred to specialise abroad for better exposure/opportunities (48.3%), while for 15.5%, their preferred courses are not currently available locally. Conclusion Our findings indicated that while four major specialties are preferred, significant gender differences exist with female students leaning towards non-surgical disciplines. Students prefer specialising abroad on the pretext that foreign centres offer better training opportunities, and many specialist programmes are unavailable locally. Electronic supplementary material The online version of this article (doi:10.1186/s13104-017-2523-y) contains supplementary material, which is available to authorized users.

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

Although surveillance for rubella does not exist in Nigeria, a measles case-based surveillance system was introduced in 2005 as one of the strategies for measles morbidity control, and included laboratory testing for confirmation of the disease. In this report, we provide the epidemiological distribution of rubella-confirmed cases reported from the south-west zone of the country, and predict the expected number of cases in the ensuing years. A descriptive analysis was carried out of rubella cases reported in the measles case-based surveillance data from the south-west zone of Nigeria for the period 2007-2012. Using an additive time series model, we predicted the expected number of cases until the year 2015. Four hundred and thirty-eight (5.4%) rubella cases were confirmed from 8 046 suspected measles cases. Cases were confirmed from all six states within the zone. The majority (87.3%) were individuals < 15 years of age and 40.9% were female. Seasonal variation existed, with peaks of infection in the first and third triannual periods of the year, while annual trends showed peaks in 2007 and 2010. Based on projections, there was a reduction in the number of expected cases. Rubella testing, in parallel with measles case-based surveillance, provides understanding of the epidemiology of rubella infection in south-west Nigeria.

Our study aims at determining the pattern of willingness of clients to pay for childhood immunization services in urban and rural primary health centers of Enugu state, Nigeria. Using a cross-sectional design, 800 clients who presented with their children/wards to receive childhood immunization services were selected at the primary health center in rural and urban local government areas of the state. The mean age was 28.9±4.5 and 26.7±5.1 years in the urban and rural areas respectively. About 54.5% of clients in the urban and 55.3% in the rural area were willing to pay for immunization services. The clients willingness to pay was influenced by: non satisfaction with immunization services, (OR=0.3, 95%CI: 0.2- 0.5), younger age, (OR=1.4, 95%CI: 1.0-2.0) marital status (OR=2.8, 95%CI: 1.2-6.5), proximity to health centers (OR=0.6, 95%CI: 0.4- 0.8), and delivering in a private health facility (OR=0.4, 95%CI: 0.1-0.9). The study suggests that the economic value that clients give to immunization services was similar in the rural and urban areas, and this could be increased by improving the level of clients’ satisfaction for the services among others.

BACKGROUND: The morbidity and mortality caused by breast cancer can be decreased by early detection with breast self-examination (BSE). The objective of this study was to determine the prevalence and the factors determining the practice of BSE. MATERIALS AND METHODS: The study was conducted on 140 women aged above 18 years who presented consecutively in a General Outpatient's clinic in a tertiary hospital in Nigeria. This was the baseline study from an intervention study which looked at the effect of demonstration of BSE on improving Clinical Breast Examination (CBE) among two groups of respondents. Structured questionnaires were validated and administered by an interviewer and the data were analyzed using Statistical Package for Social Sciences (SPSS) version 12. RESULTS: The overall self-reported prevalence of BSE practice was 62.1% among the respondents. Older women (16, 76.2%), married women (63, 65.6%) and women with tertiary education (51, 68.9%) had the highest prevalence of BSE practice. Prevalence rate was highest for civil servant (25, 78.1%), P = 0.04. The practice of BSE was higher among women with a previous history of breast disease (15, 68.2%) and in respondents with a family history of breast disease (7, 63.6%), Only 11 (12.6%) performed BSE as per guidelines, which was once in a month. CONCLUSION: The prevalence of BSE was found to be high, especially in those with tertiary education and in those with a past personal or family history of breast disease. In resource-constrained countries, BSE is a screening tool that can be employed to help reduce the breast cancer burden because routine mammography screening is not yet feasible. Women need to be informed about the when and how to perform BSE.

This study was conducted to identify determinants of complete immunization status among children aged 12-23 months in a southern district of Nigeria. The World Health Organization cluster survey was used to evaluate immunization coverage of infants. Mothers of 525 children selected by the two-stage sampling method and interviewed using an adapted questionnaire responded. Completion of the immunization schedule was verified by an immunization card or by reported history indicating that the child had received full doses of four of the antigens included in the Nigeria routine immunization schedule. Multivariate logistic regression was used to identify factors associated with completion of immunization. Only 32.4% of children had completed the immunization schedule. Determinants of complete immunization status included a maternal age less than 30 years (AOR=2.26, 95% CI:1.27-4.03), availability of an immunization card at first contact (AOR=7.72, 95% CI:4.43-13.44), fewer than three children (AOR=2.22, 95% CI:11.1-4.42), completion of post secondary education (AOR=2.34, 95% CI:1.12-4.47) and maternal unemployment (AOR=1.71, 95% CI:1.01-2.89). Identifying mothers whose children are at risk of not completing the immunization schedule and educating them is an important strategy to improve antigen coverage and prevent early childhood deaths from diseases like tuberculosis, poliomyelitis, tetanus, diphtheria, pertussis and measles.

On 19 August 2011, 11 suspected cholera cases were reported by three private hospitals to the Disease Surveillance Unit of Ede District in Osun State, Nigeria. Diagnoses were confirmed using the cholera rapid diagnostic test kit. A field investigation to provide descriptive epidemiology of the outbreak was conducted. There were 148 cases and eight deaths, giving a case fatality rate of 5%. Twelve of the 30 districts in the state were affected. Female cases constituted more than half (51%, n = 76). The distribution of cases by age category showed a higher incidence in the age group ≥ 15 years (61%, n = 90). The need to monitor the occurrence of cases closely and to provide continuous public enlightenment on household hygienic practices was emphasised.

Introduction: Femoral nerve block, when used solely or as a supplement to general anaesthesia, provides anaesthesia and analgesia to the anterior thigh. In spite of its established benefits, femoral nerve block is still underutilized in Nigeria. Our objective was to study the dimensions of femoral nerve at the level of the inguinal ligament and inguinal crease using a cadaveric model; no such data exists in Nigeria. Materials and Methods: Using 7 adult human cadavers (6 males and 1 female), the depth and thickness of the femoral nerve were measured at the levels of inguinal ligament and inguinal crease. The spatial relationship of femoral nerve to the surrounding structures was also observed. Result: The study showed a significantly wider thickness and shorter depth of the femoral nerve at the level of inguinal crease relative to inguinal ligament. Conclusion: We concluded that in centers where ultrasound and neurostimulation techniques for femoral nerve block in Nigerians are unavailable, the inguinal crease level where the femoral nerve is more supericial and wider in thickness would be the landmark of choice compared to the inguinal ligament level.

Summary Objective To determine the completeness of reporting of suspected measles cases to a local health authority in southern Nigeria. Study design Retrospective. Methods Suspected measles cases were identified in all 23 health facilities in Aniocha South Local Government Area (LGA) of Delta State, Southern Nigeria by retrospective review of the health facilities' registers and the LGA surveillance records between 1 January 2007 and 30 June 2008. A capture–recapture method was used to obtain an estimate of the total number of measles cases expected for the study area within the study period. The completeness of reporting was calculated as a ratio of the number of measles cases reported to the LGA by hospitals to the number of cases estimated by the capture–recapture method. Results An estimate of 87 measles cases was obtained with the capture–recapture method. The overall completeness of reporting was 11.5% (95% confidence interval 8.1–19.6%). Conclusion The number of suspected measles cases seems to have been grossly under-reported in this area.

Objective. To assess the awareness and attitude of antiretroviral clinic workers to HIV/AIDS and highly active antiretroviral therapy (HAART). Methods. A descriptive cross-sectional study design using a self-administered questionnaire was used. Results. Of the 43 staff, 39 (92.5%) completed the questionnaire. Their mean age was 35.1 + 7.6 years. There were 19 (48.7%) males and 20 (51.7%) females. The majority (87.2%) had tertiary education. More than three fifths (61.5%) were married. There were 20 (51.3%) professional staff and 19 (48.7%) support staff. Only 28.2% of staff members had ever received on-the-job training in HIV/AIDS care. None of the adherence counselors had ever received any training in HIV/AIDS care and HAART adherence counseling. Despite this lack of training, this majority of the clinic staff had good knowledge about and a positive attitude to HIV/AIDS and HAART adherence. Conclusion. Adherence counselors and support staff required on-the-job training for optimum job performance.

Summary Objectives Despite the availability of vaccines, children are the people most often affected by epidemic meningococcal meningitis. The pattern of the epidemic meningococcal meningitis outbreak in Northern Nigeria in 2009 and the Neisseria meningitidis strains responsible for this epidemic are described here. Methods A retrospective cross-sectional study was conducted in 16 states, involving 48 local government areas (LGAs), 91 health facilities, and 96 communities. Data collection involved in-depth interviews with key informants from the federal to the community level, a review of records, and a solution-oriented national workshop with participants from all states of the Federation. Cerebrospinal fluid (CSF) samples were collected from some of the suspected cases at the start of the outbreak and were tested using the rapid Pastorex latex agglutination kit. Results Kastina (11153, 20.4%), Jigawa (8643, 15.8%), Bauchi (8463, 15.5%), Kano (6811, 12.4%), and Gombe (6110, 11.2%) were the states with the highest prevalence of meningitis. The states of Nasarawa (11.0%), Adamawa (8.0%), and Borno (7.6%) recorded the highest percentage of deaths, while the Shongom (Gombe State 12.5%), Illela (Sokoto State 9.8%), and Ikara (Kaduna State 9.1%) LGAs recorded the most deaths amongst cases seen. Conclusions The testing of CSF samples during meningitis outbreaks is recommended in order to monitor the occurrence of the multiple meningitis serotypes during these outbreaks and to direct serotype-specific vaccination response activities.

BACKGROUND: In a retrospective survey, we found 1% cases with complete and partial failure of spinal anesthesia for cesarean delivery between 2008 and 2010, which we attributed to underreporting because of the study design. In this prospective study, we determined the incidence of failed spinal anesthesia and identified the factors that increased its risk. METHODS: This prospective, observational study consisted of all spinal anesthetics administered for cesarean delivery surgery from January 2011 to December 2013. Our definition of failure covered complete (preoperative) failure to achieve a pain-free operative condition and pain during surgery (intraoperative failure). RESULTS: Of a total of 3568 cesarean deliveries, there were 3239 (90.8%) spinal blocks, and the overall failure was 294 (9.1%). These were rescued by conversion to general anesthesia (22.8%) and repeating spinal (23.1%) and IV analgesic supplementation (54.1%). Analysis by logistic regression model indicated that factors associated with failure were the level of experience of the anesthesia provider as shown by senior registrar (adjusted risk ratio [RR], 1.4; 95% confidence interval [CI], 1.0–1.9), >1 lumbar puncture attempt (adjusted RR, 1.5; 95% CI, 1.1–1.9), and use of the L4/L5 interspace (adjusted RR, 1.7; 95% CI, 1.4–2.0). CONCLUSIONS: The rate of failed spinal anesthesia from this study was high. The independent predictors of failure were multiple lumbar puncture attempts, use of the L4/L5 interspace, and the level of experience of the anesthesia provider. It is imperative to develop clear guidelines to standardize our obstetric spinal anesthetic practice as well as the management of failures.

Background: In the absence of established guidelines, where formal screening is unavailable for birth defects, a lot of responsibility is placed on parents in the recognition of these defects. Objectives : The aim of the study was to determine the awareness of mothers about birth effects in a developing country and assess what they know about the prevention, detection and treatment of children with birth defects. Methods: This was a descriptive cross-sectional study of 714 mothers consecutively selected at two major hospitals in Nigeria between May and December, 2012. Data were collected with interviewer administered questionnaires. Descriptive and inferential statistics were performed using SPSS and statistical significance set at p

Introduction : In July 2014, Nigeria experienced an outbreak of Ebola virus disease following the introduction of the disease by an ill Liberian Traveler. The Government of Nigeria with the support of Technical and Development Partners responded quickly and effectively to contain the outbreak. The epidemiological profile of the outbreak that majorly affected two States in the country in terms of person, place and time characteristics of the cases identified is hereby described. Methods : Using field investigation technique, all confirmed and probable cases were identified, line-listed and analysed using Microsoft Excel 2007 by persons, time and place. Results : A total of 20 confirmed and probable cases; 16 in Lagos (including the index case from Liberia) and 4 in Port Harcourt were identified. The mean age was 39.5 ± 12.4 years with over 40% within the age group 30-39 years. The most frequent exposure type was direct physical contact in 70% of all cases and 73% among health care workers. The total case-fatality was 40%; higher among healthcare workers (46%) compared with non-healthcare workers (22%). The epidemic curve initially shows a typical common source outbreak, followed by a propagated pattern. Conclusion : Investigation revealed the size and spread of the outbreak and provided information on the characteristics of persons, time and place. Enhanced surveillance measures, including contact tracing and follow-up proved very useful in early case detection and containment of the outbreak.

Background : We assessed job satisfaction among anesthesiologists at a tertiary hospital in Nigeria and identified elements of job stress and dissatisfaction. Methods : A cross-sectional study design was employed; a structured self-administered questionnaire was distributed, which focused on sociodemographic data, rating of job satisfaction, identification of stressors, and work relationships. Results : Out of 55 questionnaires distributed, 46 (83.6%) completed questionnaires were returned. Overall, 27 (58.7%) of the anesthesiologists were satisfied with their job. While 8.7% were very satisfied (grade 5), 6.5% were very dissatisfied (grade 1) with their job. The stressors identified by the respondents were time pressures, long working hours with complaints of insufficient sleep, and employment status. Among the respondents, the medical officers were the most discontented (9 out of 12, 75%), followed by senior registrars (5 out of 9, 56%). A high percentage of participants (54.1%) declared that the one change if implemented that would enhance their job satisfaction was having a definite closing time. Conclusion : Our results showed that despite the demanding nature of anesthesiology as a specialty, many anesthesiologists were contented with their job.

Epidemic prone diseases threaten public health security. These include diseases such as cholera, meningitis, and hemorrhagic fevers, especially Lassa fever for which Nigeria reports considerable morbidity and mortality annually. Interestingly, where emergency epidemic preparedness plans are in place, timely detection of outbreaks is followed by a prompt and appropriate response. Furthermore, due to the nature of spread of Lassa fever in an outbreak setting, there is the need for health-care workers to be familiar with the emerging epidemic management framework that has worked in other settings for effective preparedness and response. This paper, therefore, discussed the principles of epidemic management using an emergency operating center model, review the epidemiology of Lassa fever in Nigeria, and provide guidance on what is expected to be done in preparing for epidemic of the disease at the health facilities, local and state government levels in line with the Integrated Disease Surveillance and Response strategy.

Background Lassa fever is highly contagious and commonly results in death. It is therefore necessary to diagnose and report any suspected case of Lassa fever to facilitate preventive strategies. This study assessed the preparedness of physicians in the diagnosis and reporting of Lassa fever. Methods The study design was descriptive cross-sectional. The consenting medical doctors completed a self-administered questionnaire on the diagnosis and reporting of Lassa fever. Descriptive and inferential statistics were used in data analyses. Results One hundred seventy-five physicians participated in the study. The mean age was 41.5 ± 10.9 years (range, 24–75 years). Most of the physicians were male (78.9%) and had practiced medicine ≥ 20 years (51.5%). Most of the physicians had a good knowledge regarding the diagnosis and reporting of Lassa fever; however, none of the physicians had ever diagnosed or reported a suspected case. Predictors of good knowledge include male sex, not practicing at a secondary health care level and post graduation year more than 20 years. Conclusion There is disparity in knowledge and practices of physicians regarding the diagnosis and reporting of Lassa fever. Thus, it is necessary to improve the knowledge and practices of physicians regarding the diagnosis and reporting of Lassa fever.

BACKGROUND High dropout rates in the uptake of oral polio vaccine (OPV) and DTP vaccine persist despite efforts to improve immunisation coverage. This study identified determinants of uptake of third doses of OPV3 and DTP3 among infants who received first doses of either or both vaccines at immunisation centres in the Ibadan North Local Government Area of Nigeria. METHODS Using a cohort study design, 400 mother-child pairs were assessed. A semi-structured, interviewer-administered questionnaire was used to collect data from each participant who were followed up for 90 days. Dates of subsequent doses of the vaccines were recorded. Multivariate analysis was performed using the log-rank test and Cox's regression analysis to identify predictive factors. RESULTS Only 43.5% (174/400) and 24.8% (89/359) of children completed the OPV3 and DTP3 vaccines, respectively. Factors predictive of uptake of OPV3 were first birth (HR=1.66, 95% CI 1.11-2.48) and attending a tertiary health facility (HR=2.27, 95% CI 1.41-3.65), while attending a secondary health facility was significant for DTP3 uptake (HR=2.43, 95% CI 1.30-4.61). CONCLUSIONS Uptake of third doses of vaccines was influenced by the type of health facility attended and the child birth order. Efforts to reduce vaccination dropouts should include creation of awareness of the importance of completing immunisation schedules for children of higher birth orders as well as improved service delivery at health facilities.

INTRODUCTION: This study was conducted to assess the direct cost of care and its determinants among surgical inpatients at university College Hospital, Ibadan. METHODS: A retrospective review of records of 404 inpatients that had surgery from January to December, 2010 was conducted. Information was extracted on socio-demographic variables, investigations, drugs, length of stay (LOS)and cost of carewith a semi-structured pro-forma. Mean cost of care were compared using t-test and Analysis of variance (ANOVA). Linear regression analysis was used to identify determinants of cost of care.Level of significance of 5% was used. In year 2010 $1 was equivalent to 150 naira ($1=naira 150). RESULTS: The median age of patients was 30 years with inter-quartile range of 13-42 years. Males were 257(63.6%).The mean overall cost of care was naira 66,983 , naira 31,985. Cost of surgery is about 50% of total cost of care.Patient first seen at the Accident and Emergency had a significantly higher mean cost of care of , = naira 17,207(95% CI: naira 4,003 to naira 30,410). Neuro Surgery (=naira 36,210), and Orthopaedic Surgery versus General Surgery(=naira 10,258),and Blood transfusion (=naira 18,493) all contributed to cost of care significantly. Increase of one day in LOS significantly increased cost of care by naira 2,372.57. CONCLUSION: The evidence evaluated here shows that costs and LOS are interrelated. Attempt at reducing LOS will reduce the costs of care of surgical inpatient.