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Objectives: COVID-19 vaccine was rolled out for the public in August 2021 in Zamfara state, Northen Nigeria. We determined the factors influencing COVID-19 vaccine acceptance., Settings: We executed a community-based analytical cross-sectional study during the first 4 months of the second phase of the COVID-19 (Oxford/AstraZeneca) mass vaccination campaign in Zamfara state., Participants: We used multistage sampling to select 910 household heads., Outcome Measures: We used a semistructured electronic questionnaire to collect data on sociodemographic characteristics, uptake and acceptance of COVID-19 vaccine between 12 October and 20 December 2021. We calculated frequencies, proportions, adjusted ORs and 95% CIs for factors influencing COVID-19 vaccine acceptance using logistic regression., Results: Our respondents had a median age of 48 years (IQR: 37-55), 78.1% (711) were men, a majority more than 30 years, and only 8.9% (81) had received COVID-19 vaccine. Of the 829 unvaccinated respondents, 10.1% (84) accepted to take the vaccine, the current week of the interview while 12.2% (101) rejected the vaccine. Individuals aged 30 years and older (adjusted OR (aOR)=2.39, 95% CI 1.16 to 4.94, p=0.018), who owned a mobile phone (aOR=25.35, 95% CI 11.23 to 57.23, p<0.001) and a television (aOR=3.72, 95% CI 1.09 to 12.69, p=0.036), with medium-high levels of trust (aOR=7.41, 95% CI 3.10 to 17.74, p<0.001), and those with a medium-high (positive) levels of attitude (aOR=1.82, 95% CI 1.06 to 3.11, p=0.029) were more likely to accept the COVID-19 vaccine. Also, those who had been vaccinated with other vaccines (aOR=2.2, 95% CI 1.09 to 4.43, p=0.027) and those previously tested for COVID-19 (aOR=2.0, 95% CI 1.10 to 3.66, p=0.023) were also more likely to accept it., Conclusion: COVID-19 vaccine had a poor uptake and acceptance. Factors such as age, awareness, trust and previous vaccination experience played a significant role in COVID-19 vaccine acceptance. We recommended targeted public health campaigns, improving community engagement and building trust in community leaders, healthcare providers and public health institutions., Competing Interests: Competing interests: UC is a member of the BMJ’s Editorial Advisory Team but was not in any capacity involved in the editorial process or decision for this article. All other authors have no completing interest to declare., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Durable and efficient Fe-based electrocatalysts in alkaline freshwater/seawater electrolysis is highly desirable but persists a significant challenge. Herein, we report a durable and robust heterogenous nitrogen-doped FeMoO 4 /Mo 2 N rod-shaped catalyst on nickel foam (denoted NF@FMO/MN) affording hydrogen evolution reaction (HER) low overpotentials of 23/29 mV@10 mA cm -2 and 112/159 mV@100 mA cm -2 in both alkaline freshwater/seawater electrolytes, respectively. These results are significantly superior to the pristine FeMoO 4 catalyst. Theoretical calculations consistently reveals that the combination of N-FeMoO 4 and Mo 2 N effectively reduces water activation energy barrier, modulates the sluggish water-dissociation kinetics and accelerates the hydrogen adsorption process for efficient HER. The enhanced HER performance of the as-designed NF@FMO/MN catalyst is attributed to the in situ hetero-interfacial engineering between N-doped FeMoO 4 and Mo 2 N. This present work nurtures the progress of FeMo-based electrocatalysts in alkaline freshwater/seawater electrolysis., (© 2024 Wiley-VCH GmbH.)

The development of high-performance sodium-ion batteries (SIBs) relies on enhancing the electrochemical properties of the electrodes, particularly the transition metal compounds (TMCs) through effective carbon coatings. Herein, a straightforward approach using polymerized natural pitch-derived carbon (PNPC) via step-growth polymerization regulates the lattice strain in Ni 3 S 2 -NiO heterostructures (NSNO) on nickel foam (NF). This method replaces the complex multistep carbon coatings with a cost-effective liquid-phase application of PNPC, followed by pyrolysis to create PNPC@NSNO/NF. Comparative analysis shows that PNPC effectively modulates lattice strain, achieving 3.50% tensile strain compared to 5.60% for non-polymerized carbon. The optimized PNPC@NSNO/NF electrode exhibits exceptional high areal capacity of 2.72 mAh cm -2 @1 mA cm -2 , impressive rate capability, and 97.28% capacity retention after 200 cycles. The enhanced contact area and electrical conductivity provided by the PNPC improve charge transfer kinetics and overall performance. Theoretical analyses confirm that the PNPC@NSNO/NF electrode with 3.50% lattice strain lowers the Na⁺ diffusion barrier, enhances charge transfer, and improves charge distribution, boosting the electrode performance. This work establishes a straightforward method for synthesizing lattice-strained SIB anodes, highlighting its potential for advancing SIB technology., (© 2024 Wiley‐VCH GmbH.)

Active sites, mass loading, and Li-ion diffusion coefficient are the benchmarks for boosting the areal capacity and storage capability of electrode materials for lithium-ion batteries. However, simultaneously modulating these criteria to achieve high areal capacity in LIBs remains challenging. Herein, MoS 2 is considered as a suitable electroactive host material for reversible Li-ion storage and establish an endogenous multi-heterojunction strategy with interfacial Mo-C/N-Mo-S coordination bonding that enables the concurrent regulation of these benchmarks. This strategy involves architecting 3D integrated conductive nanostructured frameworks composed of Mo 2 C-MoN@MoS 2 on carbon cloth (denoted as C/MMMS) and refining the sluggish kinetics in the MoS 2 -based anodes. Benefiting from the rich hetero-interface active sites, optimized Li adsorption energy, and low diffusion barrier, C/MMMS reaches a mass loading of 12.11 mg cm -2 and showcases high areal capacity and remarkable rate capability of 9.6 mAh cm -2 @0.4 mA cm -2 and 2.7 mAh cm -2 @6.0 mA cm -2 , respectively, alongside excellent stability after 500 electrochemical cycles. Moreover, this work not only affirms the outstanding performance of the optimized C/MMMS as an anode material for supercapacitors, underscoring its bifunctionality but also offers valuable insight into developing endogenous transition metal compound electrodes with high mass loading for the next-generation high areal capacity energy storage devices., (© 2024 Wiley‐VCH GmbH.)

Vanadium-based materials, due to their diverse valence states and open-framework lattice, are promising cathodes for aqueous zinc ion batteries (AZIBs), but encounters the major challenges of in situ electrochemical activation process, potent polarity of the aqueous electrolyte and periodic expansion/contraction for efficient Zn 2+ storage. Herein, architecting vanadium nitride (VN) nanosheets over titanium-based hollow nanoarrays skeletal host (denoted VNTONC) can simultaneously modulate address those challenges by creating multiple interfaces and maintaining the (1 1 1) phase of VN, which optimizes the Zn 2+ storage and the stability of VN. Benefiting from the modulated crystalline thermodynamics during the electrochemical activation of VN, two outcomes are achieved; I) the cathode transforms into a nanocrystalline structure with increased active sites and higher conductivity and; II) a significant portion of the (1 1 1) crystal facets is retained in the process leading to the additional Zn 2+ storage capacity. As a result, the as-prepared VNTONC electrode demonstrates remarkable discharge capacities of 802.5 and 331.8 mAh g -1 @ 0.5 and 6.0 A g -1 , respectively, due to the enhanced kinetics as validated by theoretical calculations. The assembled VNTONC||Zn flexible ZIB demonstrates excellent Zn storage properties up to 405.6 mAh g -1 , and remarkable robustness against extreme operating conditions., (© 2024 Wiley‐VCH GmbH.)

Flexible lithium-ion batteries (FLIBs) are intensively studied using free-standing transition metal oxides (TMOs)-based anode materials. However, achieving high areal capacity TMO-based anode materials is yet to be effectively elucidated owing to the poor adhesion of the active materials to the flexible substrate resulting in low active mass loading, and hence low areal capacity is realized. Herein, a novel monolithic rutile TiO 2 microparticles on carbon cloth (ATO/CC) that facilitate the flower-like arrangement of TiO 2 nanowires (denoted ATO/CC/OTO) is demonstrated as high areal capacity anode for FLIBs. The optimized ATO/CC/OTO anode exhibits high areal capacity (5.02 mAh cm -2 @0.4 mA cm -2 ) excellent rate capability (1.17 mAh cm -2 @5.0 mA cm -2 ) and remarkable cyclic stability (over 500 cycles). A series of morphological, kinetic, electrochemical, in situ Raman, and theoretical analyses reveal that the rational phase boundaries between the microparticles and nanowires contribute to promoting the Li storage activity. Furthermore, a 16.0 cm 2 all-FLIB pouch cell assembled based on the ATO/CC/OTO anode and LiNiCoMnO 2 cathode coated on ATO/CC (ATO/CC/LNCM) exhibits impressive flexibility under different folding conditions, creating opportunity for the development of high areal capacity anodes in future flexible energy storage devices., (© 2024 Wiley‐VCH GmbH.)

Valence modulation of transition metal oxides represents a highly effective approach in designing high-performance catalysts, particularly for pivotal applications such as the hydrogen evolution reaction (HER) in solar/electric water splitting and the hydrogen economy. Recently, there has been a growing interest in high-valence transition metal-based electrocatalysts (HVTMs) due to their demonstrated superiority in HER performance, attributed to the fundamental dynamics of charge transfer and the evolution of intermediates. Nevertheless, the synthesis of HVTMs encounters considerable thermodynamic barriers, which presents challenges in their preparation. Moreover, the underlying mechanism responsible for the enhancement in HVTMs still needs to be discovered. Hence, the universal synthesis strategies of the HVTMs are discussed, and direct Raman spectroscopic evidence for intermediates regulation is revealed to guide the further design of the HVTM electrocatalysts. This work offers new insights for facile designing of HVTMs electrocatalysts for energy conversion and storage through adjusting the reaction pathway., 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 © 2024 Elsevier Inc. All rights reserved.)

Background: Influenza is a leading cause of morbidity and mortality globally. Little is known of the true burden and epidemiology of influenza in Africa. Nigeria has a sentinel surveillance system for influenza virus (IFV). This study seeks to describe the epidemiological characteristics of influenza cases in Nigeria through secondary data analysis of the sentinel surveillance data from 2010 to 2020., Methodology: A retrospective secondary data analysis of data collected from patients with influenza-like illness (ILI) and severe acute respiratory infection (SARI) in the four Nigeria Influenza Sentinel Surveillance sites from January 2010 to December 2020. Data was cleaned and analyzed using Microsoft Excel and Epi info 7.2 for frequencies and proportions. The results of the analysis were summarized in tables and charts., Results: A total of 13,828 suspected cases of influenza were recorded at the sentinel sites during the study period. About 10.3% (1421/13,828) of these tested positive for IFV of which 1243 (87.5%) were ILI patients, 175 (12.3%) SARI patients, and 3 (0.2%) novel H1N1 patients. Males accounted for 54.2% (770/1421) of the confirmed cases. The median age of confirmed cases was 3 years (range: <1month-97 years). Children 0-4 years accounted for 69.3% (985/1421) of all cases. The predominant subtypes were B lineage not determined (32.3%), A/H1N1 pdm09 (28.8%) and A/H3 (23.0%). There were periods of sustained transmission in most years with 2011 having the highest number of cases. Overall, there were more cases around January to March and August to November. Heart disease and chronic shortness of breath were the most common co-morbidities identified among confirmed cases., Conclusion: Influenza remains a significant cause of respiratory illness, especially among children aged less than 4 years. Influenza cases occur all year round with irregular seasonality in Nigeria. Children less than 4 years and those with co-morbidities should be prioritized for vaccination. Vaccine composition in the country should take cognizance of the prevailing strains which are type B (lineage not determined), A/H1N1 pdm09 and A/H3., Competing Interests: Declaration of Competing Interest I declare that this manuscript is original and has not been published before. It is not currently being considered for publication elsewhere. No financial support was received for this study. As the corresponding author, I have approved the final version of the manuscript and agree to be accountable for all aspects of this work., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Nickel nitride (Ni 3 N) is a promising electrocatalyst for the hydrogen evolution reaction (HER) owing to its excellent metallic features and has been demonstrated to exhibit considerable activity for water oxidation. However, its undesirable characteristics as an HER electrocatalyst due to its poor unfavourable d-band energy level significantly limit its water dissociation kinetics. Herein, the HER electrocatalytic activity of Ni 3 N was prominently enhanced via the simultaneous incorporation of bi-cations (vanadium (V) and iron (Fe), denoted as V-Fe-Ni 3 N). The optimized V-Fe-Ni 3 N displays impressive performance with an overpotential of 69 mV at 10 mA cm -2 and good stability in 1.0 M KOH, which is remarkably better than pristine Ni 3 N, V-doped Ni 3 N, and Fe-doped Ni 3 N and considerably closer to a commercial Pt/C catalyst. Based on density functional theory (DFT) studies, V and Fe atoms not only serve as active sites for promoting water dissociation kinetics but also tune the electronic structure of Ni 3 N to achieve optimized hydrogen adsorption capabilities. This work presents an inclusive understanding of the rational designing of high-performance transition metal nitride-based electrocatalysts for hydrogen production. Its electrocatalytic performance can be significantly enhanced by doping transition metal cations.

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.)

The current development of single electrocatalyst with multifunctional applications in overall water splitting (OWS) and zinc-air batteries (ZABs) is crucial for sustainable energy conversion and storage systems. However, exploring new and efficient low-cost trifunctional electrocatalysts is still a significant challenge. Herein, the antiperovskite CuNCo 3 prototype, that is proved to be highly efficient in oxygen evolution reaction but severe hydrogen evolution reaction (HER) performance, is endowed with optimum HER catalytic properties by in situ-derived interfacial engineering via incorporation of molybdenum (Mo). The as-prepared Mo-CuNCo 3 @CoN nanowires achieve a low HER overpotential of 58 mV@10 mA cm -2 , which is significantly higher than the pristine CuNCo 3 . The assembled CuNCo 3 -antiperovskite-based OWS not only entails a low overall voltage of 1.56 V@10 mA cm -2 , comparable to most recently reported metal-nitride-based OWS, but also exhibits excellent ZAB cyclic stability up to 310 h, specific capacity of 819.2 mAh g -1 , and maximum power density of 102 mW cm -2 . The as-designed antiperovskite-based ZAB could self-power the OWS system generating a high hydrogen rate, and creating opportunity for developing integrated portable multifunctional energy devices., (© 2023 Wiley-VCH GmbH.)

The direct oxidation of three-dimensional nickel foam (3D NF) to nickel oxide (NiO) as integrated anode material for lithium-ion batteries (LIBs) has attracted significant attention towards achieving high-areal-capacity and high-energy density LIBs. However, the rate capability of such monolithic NiO in LIBs usually falls off rapidly due to the poor electrical conductivity that hindered its ionic transport kinetics. Herein, to ease the ionic transport constrains, a surfactant-regulated strategy is developed for preparing in-situ core-double-shell architecture that consists of core nickel skeleton, dense nickel oxide shell and porous nickel oxide nanosheets (NS) shell as anode materials for LIBs. Among the three employed surfactants including cationic surfactant, anionic surfactant and nonionic surfactant, the anionic surfactant (sodium dodecyl sulfate, SDS) modulated anode denoted SDS-NF@NiONS exhibits ultrahigh reversible areal capacity of 8.64 mAh cm -2 @ 0.4 mA cm -2 , and excellent rate areal capacity of 5.20 mAh cm -2 @ 3.0 mA cm -2 , which did not only show the best ever reported NiO-based high-areal-capacity based electrodes, but also demonstrate impressive performance in practical full cell LIBs. In addition, in-situ Raman and kinetic analyses confirm the mechanism of Li-ion storage and facile ionic transport kinetics in this proposed design., 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 © 2023 Elsevier Inc. All rights reserved.)

Introduction: globally, HIV infection among prison inmates is significantly higher than in the general population. Therefore, it is important to identify inmates-living-with-HIV, through HIV-testing, in keeping with the target of UNAIDS vision 90-90-90. We assessed HIV/AIDS-related knowledge, HIV-risk perception and predictors of HIV-testing-uptake in Bauchi Prison., Methods: we conducted a cross-sectional study among 310 inmates selected with 2 stage sampling. Data was collected using a pretested, structured, interviewer-administered questionnaire. Inmates that consented to HIV-test were tested. We estimated inmates' knowledge about HIV/AIDS, the level of HIV testing uptake and predictors of HIV testing-uptake using multiple logistic regression at 5% significant level., Results: the mean age (SD) was 32.3 (±9.4) years and 94.8% were males, 47.1% (95% CI: 41.6-52.7) of the respondents had good knowledge of HIV/AIDS. Fifty-five percent (95% CI: 49.9-60.9) felt they were not at risk of contracting HIV. Uptake of HIV-testing was 58.1% (95% CI: 52.5-63.4). Independent predictors for the uptake of HIV-testing were age 35-44 years (aOR= 3.3; 95% CI: 1.4-7.7), positive risk perception (aOR= 3.3; 95% CI: 1.8-6.2), good knowledge of HIV (aOR= 9.6; CI: 5.1-18.0) and knowing someone who had died of AIDS (aOR= 4.1; 95% CI: 1.9-6.4)., Conclusion: good knowledge of HIV/AIDS and HIV-testing-uptake was low among the inmates. We recommended the development and implementation of targeted HIV-testing interventions that cater to the specific needs of different age-groups within the prison population. The prison authority should develop prison-specific health education programme and awareness campaigns aimed at promoting accurate HIV-risk perception, improving their knowledge and help inmates make informed decisions that will prevent them from contracting HIV., Competing Interests: The authors declare no competing interests., (Copyright: Peter Okpeh Amede et al.)

Population-based cancer registries (PBCRs) are important sources of data on cancer burden in a defined population. They are a cornerstone for establishing, implementing and monitoring and evaluating a rational cancer control programme. Despite the long history of PBCRs in more developed countries of the world, PBCRs in sub-Saharan Africa are still poorly developed and cancer control is poor. Compared to PBCRs in Europe and the United States, cancer registries in sub-Saharan Africa are still functioning at a basic level. Only a few cancer registries in sub-Saharan Africa contribute data regularly to the International Agency for Cancer Registries' (IACR) GLOBOCAN and Cancer in Five Continents' publication series. In Nigeria, there have been efforts at strengthening existing PBCRs and creating new ones, and implementing national cancer control programmes. It is however unclear how successful these efforts have been. It is therefore necessary to reflect on documented activities so far in order to identify gaps and proffer solutions., Competing Interests: The author(s) declare that they have no conflict of interest., (© the authors; licensee ecancermedicalscience.)

The exploration of cost-effective multifunctional electrodes with high activity toward energy storage and conversion systems, such as self-powered alkaline water electrolysis, is very meaningful, although studies remain quite limited. Herein, a heterogeneous nickel-molybdenum (NiMo)-based electrode is fabricated for the first time as a trifunctional electrode for asymmetric supercapacitor (ASC), hydrogen evolution reaction, and oxygen evolution reaction. The trifunctional electrode consists of Ni 4 Mo and MoO 2 (denoted Ni 4 Mo/MoO 2 ) with hierarchical nanorod heterostructure and abundant heterogeneous nanointerfaces creating sufficient active sites and efficient charge transfer for achieving high performance self-power electrochemical devices. The ASC consists of the as-prepared Ni 4 Mo/MoO 2 positive electrode, showing a broad potential window of 1.6 V, and a maximum energy density of 115.6 Wh kg -1 , while the alkaline overall water splitting (OWS) assembled using the as-prepared Ni 4 Mo/MoO 2 as bifunctional catalysts only requires a low cell voltage of 1.48 V to achieve a current density of 10 mA cm -2 in aqueous alkaline electrolyte. Finally, by integrating the Ni 4 Mo/MoO 2 -based ASC and OWS devices, an aqueous self-powered OWS is assembled, which self-power the OWS to generate hydrogen gas and oxygen gas, verifying great potential of the as-prepared Ni 4 Mo/MoO 2 for sustainable and renewable energy storage and conversion system., (© 2023 Wiley-VCH GmbH.)

Introduction: Most tobacco use begins in adolescence, causing dependence and prolonged use, and accounts for more than 8 million deaths worldwide annually. Monitoring adolescent tobacco use is critical to controlling it. Our study examined the prevalence and factors associated with tobacco use among adolescents in Nigeria., Methods: We conducted a descriptive cross-sectional study among adolescent students in Ibadan, Nigeria, aged 11 to 18 years, from March through June 2021. We used a 2-stage cluster design to select 3,199 students from 23 schools. We adapted the Global Youth Tobacco Survey Core Questionnaire, version 1.2, for data collection and used logistic regression to assess factors associated with current tobacco use. We weighted all analyses for complex survey design and differential nonresponse at school, class, and student levels., Results: Prevalence of current use of cigarettes, smokeless tobacco, or any tobacco were 1.4%, 1.1%, and 2.0%, respectively. Predictors of current tobacco use were male sex (adjusted odds ratio [aOR] = 3.13; 95% CI, 1.53-6.42); close friends as smokers (aOR = 3.10; 95% CI, 1.77-5.41); classmates as smokers (aOR = 3.12; 95% CI, 1.15-8.49); access to cigarette (aOR = 6.65; 95% CI, 2.55-17.33); perception that smoking is attractive (aOR = 3.15; 95% CI, 1.17-8.44); exposure to secondhand smoke (aOR = 2.93; 95% CI, 1.07-8.03); and internet awareness of tobacco use (aOR = 3.22; 95% CI, 1.48-7.04)., Conclusion: Prevalence of adolescent tobacco use was low in Ibadan. Predictors were peer influence, access to cigarettes, misperceptions about tobacco use, exposure to secondhand smoke, and tobacco advertising. We recommend an antitobacco campaign that uses a peer education strategy, a comprehensive enforcement of tobacco advertising, and a ban on public smoking.

Transition metal layered double hydroxides, especially nickel-iron layered double hydroxide (NiFe-LDH) shows significant advancement as efficient oxygen evolution reaction (OER) electrocatalyst but also plays a momentous role as a precursor for NiFe-based hydrogen evolution reaction (HER) catalysts. Herein, a simple strategy for developing Ni-Fe-derivative electrocatalysts via phase evolution of NiFe-LDH under controllable annealing temperatures in an argon atmosphere is reported. The optimized catalyst annealed at 340 o C (denoted NiO/FeNi 3 ) exhibits superior HER properties with an ultralow overpotential of 16 mV@10 mA cm -2 . Density functional theory simulation and in situ Raman analyses reveal that the excellent HER properties of the NiO/FeNi 3 can be attributed to the strong electronic interaction at the interface of the metallic FeNi 3 and semiconducting NiO, which optimizes the H 2 O and H adsorption energies for efficient HER and OER catalytic processes. This work will provide rational insights into the subsequent development of related HER electrocatalysts and other corresponding compounds via LDH-based precursors., (© 2023 Wiley-VCH GmbH.)

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).)

This paper describes the process for developing, validating and disseminating through a train-the-trainer (TOT) event a standardised curriculum for public health capacity building for points of entry (POE) staff across the 15-member state Economic Community of West African States (ECOWAS) that reflects both international standards and national guidelines.A five-phase process was used in developing the curriculum: phase (1) assessment of existing materials developed by the US Centers for Disease Control and Prevention (CDC), Africa CDC and the West African Economic and Monetary Union, (2) design of retained and new, harmonised content, (3) validation by the national leadership to produce final content, (4) implementation of the harmonised curriculum during a regional TOT, and (5) evaluation of the curriculum.Of the nine modules assessed in English and French, the technical team agreed to retain six harmonised modules providing materials for 10 days of intensive training. Following the TOT, most participants (n=28/30, 93.3%) indicated that the International Health Regulations and emergency management modules were relevant to their work and 96.7% (n=29/30) reported that the training should be cascaded to POE staff in their countries.The ECOWAS harmonised POE curriculum provides a set of training materials and expectations for national port health and POE staff to use across the region. This initiative contributes to reducing the effort required by countries to identify emergency preparedness and response capacity-building tools for border health systems in the Member States in a highly connected region., 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.)

Introduction: improved access to antiretroviral therapy (ART) has significantly increased the survival and quality of life of HIV-infected persons. Strict adherence to antiretroviral therapy (ART) is crucial if viral suppression must remain optimal. We assessed predictors of adherence to ART among adult patients in Cross River State (CRS), Nigeria., Methods: a cross-sectional survey was conducted among 999 adult patients on ART in selected secondary and tertiary health facilities in CRS from January to June 2017. Respondents were recruited using multistage technique. Data were collected using a pre-tested interviewer-administered questionnaire. Adherence was defined as clients taking at least 95% of their pills in the last seven days. Multivariate analysis was performed to determine predictors of adherence at 5% level of significance., Results: majority (70.5%) of the respondents were females with a mean age of 43.7 ± 11.1 years. The self-reported adherence rate was 60.1%. The commonest reasons for non-adherence was client travelling out of home, being busy, forgetting and lack of food. The significant predictor identified in this study was being on first-line drugs (OR=3.677, 95% C.I=2.523-5.358), were 3 times more likely to have good adherence. Predictors of poor-adherence were alcohol intake (OR=0.382, 95% C.I=0.262-0.559), dosing medications (OR=0.502, 95% C.I=0.381-0.661), CD4 cell count ≥ 500 (OR=0.723, 95% C.I=0.543-0.964), poor attitude to HIV status and medication (OR=0.713, 95% C.I=0.512-0.994) and family support (OR=0.736, 95% C.I=0.544-0.995)., Conclusion: adherence to ART among clients in this study was fair. Majority of the reasons for poor-adherence were client-related. There is need for targeted counselling to improve adherence., Competing Interests: The authors declare no competing interests., (Copyright: Anastasia Ikilishi Isika et al.)

Background: Malaria is a priority global health disease with high morbidity and mortality especially among children under-five and pregnant women. Malaria elimination requires an effective surveillance system. The malaria surveillance system in Benue State was evaluated to assess its attributes and performance in line with set objectives., Methods: The updated United States Centers for Disease Control and Prevention guideline for evaluating surveillance systems was used. The surveillance system's key attributes was quantitatively and qualitatively assessed. Semi-structured questionnaires were administered to all Local Government Area (LGA) Roll Back Malaria (RBM) focal persons and five key informants were interviewed at the State level. The Benue State District Health Information System-2 (DHIS-2) malaria data and monthly summary forms were reviewed from January 2015 to December 2019., Results: A total of 46 RBM focal persons and 5 key-informants participated. About 56.9% were males, the mean-age 43.8 (SD ± 9.3) years and 32 (62.8%) had ≥ 20-year experience on malaria surveillance with mean-year-experience 20.8 (SD ± 7.8) years. All 46 (100%) RBMs understood the case definition; 43 (93.5%) found it easy-to-fill the standardized data tools and understood the data flow channels. The malaria surveillance system in Benue is simple, acceptable and useful to all stakeholders, 36 (70.6%) found switching from the paper-based to the electronic-data tools with ease and 45 (88.2%) stated that analysed data were used for decision-making. Data flow from LGA to State is clearly defined, however majority of the data is collected from public health facilities through the DHIS-2 Platform. The overall timeliness and completeness of reporting was 76.5% and 95.7%, respectively, which were below the ≥ 80% and 100% targets, respectively., Conclusions: The malaria surveillance system in Benue State is simple, useful, acceptable, and flexible, but it is not representative and timely. Public-private and public-public-partnerships should be strengthened to encourage reporting from both private and tertiary health facilities and improve representativeness, and frequent feedback to improve reporting timeliness., (© 2022. The Author(s).)

The electric-field effect is an important factor to enhance the charge diffusion and transfer kinetics of interfacial electrode materials. Herein, by designing a heterojunction, the influence of the electric-field effect on the kinetics of the MoS 2 as cathode materials for aqueous Zn-ion batteries (AZIBs) is deeply investigated. The hybrid heterojunction is developed by hydrothermal growth of MoS 2 nanosheets on robust titanium-based transition metal compound ([titanium nitride, TiN] and [titanium oxide, TiO 2 ]) nanowires, denoted TNC@MoS 2 and TOC@MoS 2 NWS, respectively. Benefiting from the heterostructure architecture and electric-field effect, the TNC@MoS 2 electrodes exhibit an impressive rate performance of 200 mAh g -1 at 50 mA g -1 and cycling stability over 3000 cycles. Theoretical studies reveal that the hybrid architecture exhibits a large-scale electric-field effect at the interface between TiN and MoS 2 , enhances the adsorption energy of Zn-ions, and increases their charge transfer, which leads to accelerated diffusion kinetics. In addition, the electric-field effect can also be effectively applied to TiO 2 and MoS 2 , confirming that the concept of heterostructures stimulating electric-field can provide a relevant understanding for the architecture of other cathode materials for AZIBs and beyond., (© 2022 Wiley-VCH GmbH.)

Background: Male involvement in family planning (FP) remains low in male-dominant communities. Family planning contributes to the regulation of fertility and population growth in Nigeria. Increasing male involvement in family planning services is crucial in reducing maternal morbidity and mortality in patriarchal societies such as Nigeria. This study identified the determinants of male involvement in family planning services in Abia State, Nigeria., Methods: This was a cross-sectional study conducted in twelve communities of Abia State, Nigeria. A total of 588 married men who met the eligibility criteria were recruited using a multistage sampling technique. An interviewer-administered semi-structured questionnaire was used to collect data on the variables. Univariate, bivariate and multivariate analysis was done. The level of significance was set at 5%., Results: The overall level of active male involvement in family planning services was 55.1% (95% CI:51.0-59.2%). The mean age of the respondents was 42.4 ± 8.0 years. Access to television (aOR = 1.58, 95% CI: 1.05-2.39), spouse employment status (aOR = 2.02, 95% CI: 1.33-2.06), joint decision-making (aOR = 1.66, 95% CI: 1.05-2.62), and accompanying spouse to the FP clinic (aOR = 3.15, 95% CI: 2.16-4.62) were determinants of active male involvement., Conclusion: At least, one out of every two men was actively involved in family planning services. This was determined by access to television, employment status of spouse, joint decision-making, and accompanying spouse to the FP clinic. There is a need to focus on the identified factors in order to further improve the active involvement of men in FP services., (© 2022. The Author(s).)

Tuberculosis (TB) is a contagious disease and its transmissibility is increased in congregate settings. TB incidence rates are five-to-fifty times higher among inmates in prison settings than the general population which has a direct impact on the outcome of TB treatment. There is paucity of information on TB treatment outcomes and its associated factors in Nigerian prison settings. We therefore assessed TB treatment outcomes among inmates in prison settings in Bauchi State, Nigeria. We conducted a retrospective data analysis of inmates with TB in the five-main prison settings in Bauchi State. We extracted socio-demographic, clinical and treatment outcome characteristics from TB treatment register of inmates treated for TB between January 2014 and December 2018, using a checklist. We calculated the TB treatment success rate (TSR) and explored the relationship between the TSR and socio-demographic and clinical characteristics. Related variables were modelled in multiple logistic regression to identify factors associated with TSR at 5% level of significance. All 216 inmates were male with mean (SD) age of 37.6±11.4 years. Seventy-six (35.2%) were cured, 61 (28.2%) completed treatment, 65 (30.1%) were transferred-out without evaluation and 14 (6.5%) died. Overall TSR was 72.9%. Factors associated with successful-treatment-outcome were age, weight, imprisonment duration and HIV status. The results indicate that inmates who are 20-29 years are at least ten times more likely to be successful (aOR = 10.5; 95%CI: 3.2-35.1) than inmates who are 55 years or older. Inmates who are 30-39 years are about four times more likely to be successful than inmates who are 55 years or older (aOR = 4.2; 95% CI: 1.3-13.1). In general, the younger an inmate, the more successful he is. Inmates with pretreatment-weight; 55kg or more are 13 times more likely to be successful (aOR = 13.3; 95%CI: 6.0-29.6) than inmates with weight below 55kg. Inmates who were imprisoned for 2 years or less are about three times more likely to be successful (aOR = 2.6; 95%CI: 1.3-5.4) than inmates who were imprisoned for more than 2 years and HIV negative inmates were three times more likely to succeed (aOR = 3.3; 95%CI:1.4-7.8) than inmates who were HIV positive. We recommended that to improve TB treatment outcome among inmates; age, duration-of-imprisonment, weight and TB/HIV co-infection should be the major consideration during pretreatment, psychological and nutritional counselling and a tracking-system be developed by the authority to follow-up inmates transferred-out to other health facilities to ensure they complete the treatment and outcomes evaluated., Competing Interests: Authors have declared that no competing interests exist.

Introduction: physical inactivity has been identified as the fourth leading risk factor for global mortality due to non-communicable diseases. Prevalence rates of 91.0% and 62.2%, have been documented among civil servants in the northern and southern parts of Nigeria, respectively. There is a paucity of data regarding the relationship between physical inactivity and environmental factors among civil servants in the State. This study assessed the prevalence and perceived environmental factors associated with physical inactivity among civil servants in Abia State Nigeria., Methods: we conducted a cross-sectional study in which we recruited 440 civil servants using a multistage sampling technique. We used an interviewer-administered structured questionnaire to collect data on sociodemographic, physical activity, and neighbourhood environmental attributes. Descriptive, bivariate and multivariate analysis were done. The level of significance was set at 5%., Results: the mean age of the respondents was 39.0±9.2 years, and 61% were females. The prevalence of physical inactivity was 48.4% (95%CI: 43.7%-53.2%). The putative environmental factors included perceptions of low residential density areas, perceived absence of neighbourhood sidewalks, perceived unavailability of bicycling facilities and the perception of an unsafe neighbourhood due to night crimes. The predictor of physical inactivity was the perceived absence of neighbourhood sidewalks (aOR=2.02, 95%CI: 1.10-3.73)., Conclusion: in this study, physical inactivity is prevalent among civil servants in Abia State. The need for the stakeholders in collaboration with the Ministry of Environment to focus on the provision of sidewalk facilities, layout of residential areas and limit security risks in the State to enhance physical activity is highlighted., Competing Interests: The authors declare no competing interests., (Copyright: Chidinma Ihuoma Amuzie et al.)

Introduction: event-based surveillance (EBS) is a surveillance method involving systematic and prompt data collection on incidents of public health importance, and complements the current indicator-based surveillance system and the Integrated Disease Surveillance and Response System (IDSR). It also promotes a rapid assessment and response to public health emergencies in Nigeria, although there is a lack of information regarding the status of EBS among Public Health Stakeholders in Nigeria; hence our study aimed to assess the awareness, availability, and utility of EBS among Nigerian public health stakeholders., Methods: we conducted a cross-sectional study to assess the awareness, availability, functionality, and utilization of EBS in the 36 States in Nigeria, plus the Federal Capital Territory (FCT). We interviewed 53 stakeholders in disease surveillance and response using a self-administered, semi-structured questionnaire to obtain responses on the awareness of the event-based surveillance system, availability, and functionality. We also assessed the common structures used to report health-related events and the availability of minimum requirements for an event-based surveillance system. We performed descriptive statistics for the data obtained., Results: the majority of respondents were males and 37.7% were disease surveillance and notification officers (DSNOs). Awareness of EBS was poor with about half, 49% of the respondents reported hearing of EBS, but only 17% described it correctly. The overall level of availability of the EBS reporting structure was inadequate, 28.2% and poorly utilised in the States., Conclusion: the awareness, availability, and utilization of event-based surveillance systems are low in Nigeria. The government should improve the feasibility and utility of EBS in the States to enhance early disease detection and response., Competing Interests: The authors declare no competing interests., (Copyright: Rabi Usman et al.)

Background: Children living with HIV (CLWH) are at risk of colonisation and infection with meticillin-resistant Staphylococcus aureus (MRSA). All S. aureus isolates from CLWH with bloodstream infections in Kano were MRSA., Aim: To estimate the prevalence of nasal colonisation with S. aureus and MRSA in CLWH in Kano State and to determine associated risk factors., Methods: A cross-sectional study was performed in the infectious diseases clinics of two public hospitals in Kano involving 214 CLWH/caregiver pairs. Children were selected from clinic registers by simple random sampling and an interviewer-administered questionnaire used to elicit factors associated with MRSA carriage from the caregivers. Clinical records were reviewed for patients' medical histories. Standard laboratory techniques were used to isolate S. aureus from nasal swabs collected from CLWH. MRSA was detected using the cefoxitin disc diffusion method and PCR for mecA gene detection. We measured the prevalence of S. aureus and MRSA carriage in the CLWH and calculated adjusted odds ratios (AOR) for factors associated with MRSA., Results: Nasal S. aureus carriage in CLWH was 18.7% (40/214). Cefoxitin disc diffusion identified 6/214 (2.8%) of CLWH were MRSA carriers, while PCR identified that 9/214 (4.2%) of CLWH were MRSA carriers. Recent hospitalisation (AOR: 61.04; 95% CI: 9.01-413.38) and recent antibiotic therapy (AOR: 7.52; 95% CI: 1.07-52.95) were independent risk factors for MRSA colonisation., Conclusions: The rate of MRSA nasal colonisation among CLWH in Kano was similar to that reported in other studies in Africa. Infection prevention and control measures including MRSA screening and decolonisation, as well as education for CLWH and their carers should be introduced to reduce MRSA spread., (© 2022 The Authors.)

Introduction: identifying risk factors for SARS-CoV-2 infection and disease severity is critical to developing measures to protect vulnerable groups. We aimed to identify risk factors for SARS-CoV-2 infection and severe disease., Methods: this was an unmatched case-control study that recruited participants in the country from April to July 2020. Cases tested positive on Reverse-Transcription Polymerase Chain Reaction (RT-PCR), while controls tested negative on RT-PCR. Data were collected by trained research assistants using an interviewer-administered questionnaire. Cases were categorized into severe and non-severe to identify risk factors for severe disease., Results: there were 497 cases and 997 controls recruited. Contact with a symptomatic confirmed case adjusted odds ratio (aOR) 1.91 (95% CI: 1.30-2.80) and attendance of mass gatherings aOR 1.74 (95% CI: 1.10-2.74) were associated with SARS-CoV-2 infection, while the use of private transportation aOR 0.56 (95% CI: 0.37-0.85) and use of a face mask aOR 0.43 (95% CI: 0.19-0.95) were associated with lower odds of infection. We identified 38 (7.7%) severe cases and 459 (92.3%) non-severe cases. Multivariate analysis identified age ≥ 50 years aOR 4.54 (95% CI: 1.86-11.08), male sex aOR 2.95 (95% CI: 1.07-8.11), hypertension aOR 3.52 (95% CI: 1.46-8.50), and diabetes aOR 5.76 (95% CI: 2.01-16.50) as risk factors for severe disease, while Hausa ethnicity aOR 0.15 (95% CI: 0.04-0.62) lowered the odds of severe disease., Conclusion: our findings highlight the importance of exposure history, mass gatherings, private transportation, and the use of face masks. Being over 50 years, male and having comorbidities indicate a worse prognosis., Competing Interests: The authors declare no competing interests., (Copyright: Rowland Utulu et al.)

Introduction: The emergence of novel SARS-CoV-2 has caused a pandemic of Coronavirus Disease 19 (COVID-19) which has spread exponentially worldwide. A robust surveillance system is essential for correct estimation of the disease burden and containment of the pandemic. We evaluated the performance of COVID-19 case-based surveillance system in FCT, Nigeria and assessed its key attributes., Methods: We used a cross-sectional study design, comprising a survey, key informant interview, record review and secondary data analysis. A self-administered, semi-structured questionnaire was administered to key stakeholders to assess the attributes and process of operation of the surveillance system using CDC's Updated Guidelines for Evaluation of Public Health Surveillance System 2001. Data collected alongside surveillance data from March 2020 to January 2021 were analyzed and summarized using descriptive statistics., Results: Out of 69,338 suspected cases, 12,595 tested positive with RT-PCR with a positive predictive value (PPV) of 18%. Healthcare workers were identified as high-risk group with a prevalence of 23.5%. About 82% respondents perceived the system to be simple, 85.5% posited that the system was flexible and easily accommodates changes, 71.4% reported that the system was acceptable and expressed willingness to continue participation. Representativeness of the system was 93%, stability 40%, data quality 56.2% and timeliness 45.5%, estimated result turnaround time (TAT) was suboptimal., Conclusion: The system was found to be useful, simple, flexible, sensitive, acceptable, with good representativeness but the stability, data quality and timeliness was poor. The system meets initial surveillance objectives but rapid expansion of sample collection and testing sites, improvement of TAT, sustainable funding, improvement of electronic database, continuous provision of logistics, supplies and additional trainings are needed to address identified weaknesses, optimize the system performance and meet increasing need of case detection in the wake of rapidly spreading pandemic. More risk-group persons should be tested to improve surveillance effectiveness., Competing Interests: The authors have declared that no competing interests exist.

Introduction: Cardiovascular diseases (CVDs) now constitute major cause of morbidity and mortality in middle and low income countries including Nigeria. One of the major efforts at controlling CVDs in Nigeria includes expanding universal access to care through the primary healthcare (PHC) system. The study was to assess essential medicines and technology for control of hypertension in PHC facilities in Ebonyi Nigeria., Methods: The study used mixed method cross-sectional survey to assess availability, affordability and accessibility of essential medicines and technology in 45 facilities and among their patients with hypertension (145)., Results: Most of the PHC facilities (71.1%) assessed were rural. The heads of facilities were mainly community health extension workers (86.7%). One (2.2%) facility had a pharmacy technician. All facilities had been supervised by the regulatory authority in the last one year. Out of 15 anti-hypertensive drugs assessed, 10 were available in some facilities (2.2%-44.4%) but essential drug availability was low (<80%). Only mercury sphygmomanometers were available in all facilities with 82.2% functioning. Stethoscopes were available in all facilities and 95.6% were functional. Glucometers were present in 20.0% of facilities and were all functional. All the respondents (100.0%) reported they could not afford their anti-hypertensive drugs. Median monthly income was 8,000 Nigerian Naira (range = 2,000-52,000). Median monthly cost of anti-hypertensive drugs was 3,500 Naira (range = 1,500-10,000). For 99 (68.3%) of the respondents, the facilities were accessible. Median cost of transportation for care was 400 Naira (range = 100-2,000)., Conclusion: Gaps still exist in the provision of hypertension control services in PHC facilities in Ebonyi State, Nigeria. The essential drugs were not always available, and cost of the drugs were still a challenge to the patients. There is urgent need to expand health insurance coverage to rural communities to ameliorate the catastrophic out-of-pocket health expenditures and improve control of CVDs., Competing Interests: The authors have declared that no competing interests exist.

The outbreak of highly contagious transboundary rabbit hemorrhagic disease (RHD) in Nigeria has a severe socio-economic impact on the rabbit industry. We present the outbreak investigation and spatial epidemiology of the first confirmed RHD outbreak in Nigeria from a field survey of 28 stochastic outbreaks in Kwara State, north-central Nigeria. A total of 1,639 rabbits died from 2,053 susceptible rabbits. The serotype "RHDV-2" was detected in tissue samples from some of the outbreaks. The case fatality rate of the RHDV-2 outbreak was 79.8%. The source of the outbreak is still unknown. Most (71.4%) of the farmers had introduced new rabbits into their farms 1-2 weeks before the outbreak. Most of the farmers practiced biosecurity measures such as farm fencing (83.1%) and routine disinfection of the farm materials (53.6%). However, only 17.8% of the farmers enforced movement restrictions into their farms. Some of the farmers (42.8%) had restocked their farms after being affected by the RHD outbreak and 75% of all those farmers that have restocked had used the RHD vaccine. There was no statistically significant association between adherence to biosecurity measures and the RHD outbreak in affected farms ( p = 0.408). However, the introduction of new rabbits into rabbit farms significantly pre-disposed farms to the RHD outbreak ( p < 0.001). There is a need for active surveillance of RHD across the country to ensure efficient and effective tracking, monitoring, and control of the disease. Equally, understanding the genetic diversity of the Lagoviruses in Nigeria that cause RHD to aid vaccine development is of utmost importance to prevent future RHD outbreaks., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Oyewo, Al-Mustapha, Richards, Abdulkareem, Olasoju, Babale, Khalid, Meseko and Balogun.)

Introduction: Operational gaps in the Global Polio Eradication Initiative implementation had been partly responsible for inadequate population immunity and the continued transmission of wild poliovirus in Nigeria before the African Region was declared polio-free in 2020. Missed opportunities to provide services in nomadic populations due to frequent mobility, lack of inclusion in microplans and the remoteness of their settlements were the major challenges. During May 2013 we conducted immunization outreach to nomadic and other underserved communities in Rabah LGA, Sokoto state, and Ardo Kola LGA, Taraba state, in Nigeria to identify and vaccinate children missed during supplemental immunization activities while identifying missed acute flaccid paralysis cases., Methods: An enumeration checklist and data collection instruments on Android cell phones were used to capture socio-demographic data and GPS coordinates on nomadic settlements, households, number of children aged <5 years, children previously missed for vaccination and their locations. Local guides led trained enumerators to underserved communities for the enumeration and vaccination. Data were analyzed using Microsoft Excel 2007., Results: A total of 324 settlements were listed for the two states, and 111 (34.3%) of these were identified as missed when compared with micro-planning for the most recent SIA. In these settlements, 3,533 households and 9,385 children aged <5 years were listed. We administered oral poliovirus vaccine to all 1,946 missed children during the recent or any supplemental immunization activities. Of these, 527 (27.1%) had never been vaccinated. We found no missed acute flaccid paralysis cases., Conclusion: Nomadic populations continue to be underserved, especially for vaccination services. This results in pockets of populations with low herd immunity and increased risk for poliovirus transmission. Community leaders and nomadic settlements should be included in the micro-planning of all supplemental immunization activities to ensure all children receive vaccination services., (©Nuruddeen Aliyu et al.)

Background: With reports of surges in COVID-19 case numbers across over 50 countries, country-level epidemiological analysis is required to inform context-appropriate response strategies for containment and mitigation of the outbreak. We aimed to compare the epidemiological features of the first and second waves of COVID-19 in Nigeria., Methods: We conducted a retrospective analysis of the Surveillance Outbreak Response Management and Analysis System data of the first and second epidemiological waves, which were between 27 February and 24 October 2020, and 25 October 2020 to 3 April 2021, respectively. Descriptive statistical measures including frequencies and percentages, test positivity rate (TPR), cumulative incidence (CI) and case fatality rates (CFRs) were compared. A p value of <0.05 was considered statistically significant. All statistical analyses were carried out in STATA V.13., Results: There were 802 143 tests recorded during the study period (362 550 and 439 593 in the first and second waves, respectively). Of these, 66 121 (18.2%) and 91 644 (20.8%) tested positive in the first and second waves, respectively. There was a 21.3% increase in the number of tests conducted in the second wave with TPR increasing by 14.3%. CI during the first and second waves were 30.3/100 000 and 42.0/100 000 respectively. During the second wave, confirmed COVID-19 cases increased among females and people 30 years old or younger and decreased among urban residents and individuals with travel history within 14 days of sample collection (p value <0.001). Most confirmed cases were asymptomatic at diagnosis during both waves: 74.9% in the first wave; 79.7% in the second wave. CFR decreased during the second wave (0.7%) compared with the first wave (1.8%)., Conclusion: Nigeria experienced a larger but less severe second wave of COVID-19. Continued implementation of public health and social measures is needed to mitigate the resurgence of another wave., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: The COVID-19 pandemic has had a great toll on global health. Frontline healthcare workers (FHCW) directly involved in the treatment of COVID-19 patients have faced some physical and psychological challenges. This study explored the stigma and traumatic experiences of the FHCW during the COVID-19 pandemic in Nigeria., Methods: We recruited twenty FHCW directly involved in the treatment of COVID-19 patients through purposive and snowball sampling techniques. Face-to-face in-depth interviews were conducted for all participants, and qualitative analysis of data was done using Colaizzi's phenomenological method., Results: Five themes identified were: Early stage of the pandemic (fear, anxiety, public fright, other countries repatriating their citizens, the socio-economic impact of the pandemic and a call to duty for the FHCW); working with COVID-19 patients (excitement on patients recovery and duty stress); psychological, mental and emotional trauma; stigmatization (stigmatized by colleagues, family, friends or their residential communities, reasons for stigmatization which were fear of infection, limited knowledge of the virus and working at the isolation centre and the effect of stigma); and recommendations (education and awareness creation, government showing more care towards the FHCW and provision of health insurance for FHCW to take care of those that get infected in the line of duty)., Conclusion: Stigmatization has proven to be a major challenge for FHCW in conducting their duties. The psychological impact experienced by FHCW may affect the quality of the services rendered by these workers. The study reveals the need of education and awareness creation in the ongoing pandemic. There is a need for the government and society to acknowledge and appreciate the efforts of FHCW., (© 2021. The Author(s).)

Introduction: psychoactive substance use (PSU) is a patterned use of a drug in which the user consumes the substance in amounts or methods which are harmful to themselves or others. Psychoactive substance use takes a considerable toll on financial status, academic achievement and health status of addicts. In Nigeria, PSU is on the increase, one of the most disturbing health-related problems and a leading cause of premature death among school aged population worldwide. We therefore, determined the knowledge of health effects and determinants of psychoactive substance use among secondary school students in Sokoto Metropolis, Nigeria., Methods: we conducted a cross-sectional study among 430 secondary school students that were selected using multistage sampling in Sokoto, Northwestern, Nigeria from April to May 2019. We collected data using a semi-structured, interviewer-administered questionnaire. We calculated proportions and adjusted odds ratios (OR) with 95% confidence intervals (CI) in a binary logistic regression model., Results: knowledge of health effects of PSU was good in 38.1% of the respondents with a mean score of 19.6 ± 10.0. The overall prevalence of PSU was high among current users (16.3%), male participants (78.6%) and those aged 17-years or more (68.6%). Independent predictors of current use of psychoactive substances were poor knowledge of health effects (aOR: 4.1, 95% CI: 1.7-10.0) and father´s use of psychoactive substances (aOR: 10.3, 95% CI= 1.9-57.1)., Conclusion: knowledge of health effects of psychoactive substances was generally poor among the participants with an associated high prevalence among current users. Poor knowledge of its health effects determines the use of psychoactive substances. We conducted awareness campaigns and health talk on health effects of PSU to secondary school students in the State. The Federal Ministry of Education should ensure that PSU-related topics are incorporated in the secondary school curriculum., Competing Interests: The authors declare no competing interests., (Copyright: Auwal Usman Abubakar et al.)

Background: In disease control, the program officers are vital to the successful implementation of control strategies. However, poor knowledge of the disease and its control, staff attrition, and lack of intentional training for new staff can lead to under-performance and ineffectiveness of interventions. Thus, the Nigeria Field Epidemiology and Laboratory Training Program, in collaboration with National Malaria Elimination Program, planned a malaria short course (MSC) to strengthen the capacity of current program managers and incoming staff. To guide the development of the curriculum for the MSC, we conducted a needs assessment survey to ascertain the perceived usefulness of the MSC, the priority rating of MSC thematic domains and associated factors., Methods: Overall, 384 purposively selected respondents across ten states and the Federal Capital Territory in Nigeria were interviewed. These comprised malaria and non-malaria control program staff at state, local government area (LGA) and ward levels. We administered a structured questionnaire to elicit information on socio-demographics, training needs, priority malaria thematic domains, perceived course usefulness and willingness of ministries/organizations to release staff to attend the MSC. Data were analyzed using descriptive and inferential statistics at p<0.05., Results: Mean age was 43.9 (standard deviation: 7.6 years), 172 (44.8%) were females. Of the 384 respondents, 181 (47.1%), 144 (37.5%) and 59 (15.4%) were at the ward, LGA and state levels, respectively. Seventy-two (18.8%) had never worked in malaria control program. Majority (98.7%, n = 379) reported the need for further training, 382 (99.5%) opined that the course would be useful, and all affirmed their employers' willingness towards their participation at the training. Respondents rated high the domains of basic malariology, malaria treatment, malaria prevention, surveillance/data management, use of computers, leadership skills, program management and basic statistics. Predictors of malaria topical domains' high rating were gender (odds ratio (OR) = 6.77; 95% CI:3.55-12.93) and educational qualifications (OR = 0.48; 95% CI:0.26-0.89)., Conclusions: A malaria short course is a necessity and appropriate for program officers at different levels of health administration in Nigeria to achieve malaria elimination, taking into consideration the challenges of human resource retention. The outcome of this study should inform the curriculum and the delivery of the MSC., Competing Interests: The authors declare that they have no competing interest.

Background: COVID-19 pandemic has resulted in global health and economic crisis. We investigated the experiences of frontline health care workers recovering from COVID-19 in Lagos State Nigeria., Methods: We conducted a qualitative study among frontline health workers recovering from COVID-19 in Lagos State, Nigeria. We interviewed 12 respondents before achieving data saturation. We used a checklist to guide the interview according to the phenomenon under study. Data obtained were analyzed using Colaizzi's phenomenological method., Results: The study was summarized under five themes: knowledge of COVID-19, exposure, reactions, challenges and recommendations. The respondents were quite knowledgeable on COVID-19, their reactions when informed of their status were denial, anxiety, distress, disorientation, crying for fear of stigmatization, while some were psychologically prepared. Reactions from colleagues, family and friends were encouraging and provided solace for them with a few colleagues and families that had negative reactions. Challenges include anosmia, movement restriction, loneliness, worries about the state of their families, nondisclosure of status to family members, non-conducive isolation centre with limited space, insomnia, stigmatization by health workers at the isolation centre, extended duration of stay, delay in the release of test results and use of ambulance for evacuation to the isolation centres. Coping strategies were watching movies, phone calls, use of social media, listening to music, attending webinars, working on projects and reading spiritual books. Recommendations were early laboratory testing of samples and conveying of results, increase testing capacity, the need of health care workers to be more compassionate, better method of evacuation of people that tested positive to COVID-19, aside the use of ambulance that increases the likelihood of stigmatization and standard guideline for the case management of people recovering from COVID-19 in Lagos state., Conclusions: Respondents felt stigmatized and psychologically and morally traumatized. Isolation is a difficult experience and some negative emotions as expressed by previous studies were experienced by the respondents. There is need for increased testing capacity, timely results dissemination, early evacuation and creation of more isolation centres in Lagos State due to the rising number of cases and shortage of bed space., (© 2021. The Author(s).)

Background: Measles accounts for high morbidity and mortality in children, especially in developing countries. In 2017, about 11,190 measles cases were recorded in Nigeria, including Bauchi State. The aim of this study was to describe the trend and burden of measles in Bauchi State, Nigeria., Method: We analyzed secondary data of measles cases extracted from the Measles Surveillance data system in Bauchi State from January 2013 to June 2018. The variables extracted included age, sex, doses of vaccination, case location and outcome. Data were analyzed using descriptive statistics, logistic regression, and multiplicative time series model (α = 0.05)., Results: A total of 4935 suspected measles cases with an average annual incidence rate of 15.3 per 100,000 population and 57 deaths (Case Fatality Rate, CFR: 1.15%) were reported. Among the reported cases, 294 (6%;) were laboratory-confirmed, while clinically compatible and epi-linked cases were 402 (8%) and 3879 (70%), respectively. Of the 4935 measles cases, 2576 (52%) were males, 440 (9%) were under 1 year of age, and 3289 (67%) were between 1 and 4 years. The average annual incidence rate among the 1-4 year age-group was 70.3 per 100,000 population. The incidence rate was lowest in 2018 with 2.1 per 100,000 and highest in 2015 with 26.2 per 100,000 population. The measles cases variation index per quarter was highest in quarter 1 (198.86), followed by quarter 2 (62.21) and least in quarter 4 (10.37) of every year. Only 889 (18%) of the measles cases received at least one dose of measles vaccine, 2701 (54.7%) had no history of measles vaccination while 1346 (27.3%) had unknown vaccination status. The fatality of measles in Bauchi State were significantly associated with being under 5 years (AOR = 5.58; 95%CI: 2.19-14.22) and not having at least a dose of MCV (OR = 7.14; 95%CI: 3.70-14.29)., Conclusion: Measles burden remains high in Bauchi State despite a decrease in its incidence over the study years. Most of the cases occurred in the first quarter of every year. Improved routine measles surveillance for prompt case management could reduce the burden of the disease in Bauchi State.

Free movement between countries without a visa is allowed within the 15-country Economic Community of West African States (ECOWAS) region. However, little information is available across the region on the International Health Regulation (IHR 2005) capacities at points of entry (PoE) to detect and respond appropriately to public health emergencies such as Coronavirus Disease 2019 (COVID-19). ECOWAS and the member states can better tailor border health measures across the region by understanding public health strengths and priorities for improvement at PoEs. A comprehensive literature review was combined with a self-assessment of capacities at PoEs across the fifteen member states from February to July 2020. For the assessment, the member states completed an adapted World Health Organization (WHO) self-assessment checklist by classifying capacity for seven domains as fully, partially, or not implemented. The team implemented three focus group discussion (FGD) sessions and 13 key informant interviews (KII) with national-level border health stakeholders. Univariate analysis was used to summarize the assessment data and detailed content analysis was applied to evaluate FGD and KII results. Of the 15 member states, 3 (20%) are landlocked; 3 (20%) have more than one seaport. Eleven (73%) countries have 1 designated airport, 3 (20%) have two airports, and only one country (6.7%) has three airports. Two hundred and seventy-eight designated ground crossings were identified in 12 countries (80%). Strengths across the PoE were existence of decrees and ministerial acts in some ECOWAS countries and establishment of national taskforces for the COVID-19 response at PoE in ECOWAS. Major challenges were porous borders, poor intersectoral coordination, lack of harmonized traveler screening measures, shortage of staff, and inadequate financial resources. Despite all these challenges, there are opportunities such as leveraging the regional cross-border poliomyelitis coordination and control mechanism, and existence of networks of infection prevention and control specialists and field epidemiologists. However, political instabilities in some countries pose a threat to government commitments to PoE activities. The capacity to respond to public health emergencies at PoE in the ECOWAS region is still below IHR standard. Public health capacities at a majority of IHR-designated PoE in the 15-country region do not meet required core capacities standards., Competing Interests: The authors declare no competing interests., (Copyright: Virgil Kuassi Lokossou et al.)

Introduction: palliative care offers a care and support system to people living with Human Immunodeficiency Virus (HIV) infection/Acquired Immunodeficiency Syndrome (AIDS). In Nigeria, the palliative care (PC) practice generally is new and still developing. While most studies on HIV/AIDS assess drug treatment and adherence for people living with HIV/AIDS (PLWHA), there is paucity of data on PC services available for them. We therefore assessed the PC services offered and referral services available to PLWHA in health facilities., Methods: we conducted a cross-sectional study across all public secondary and tertiary health facilities offering HIV care services in Abuja, Nigeria between February and May 2017. We used an interviewer-administered semi-structure questionnaire to collect information from the heads of health facilities. The questionnaire assessed palliative care and referral services for PLWHA. Frequencies and proportions were calculated using Microsoft-Excel., Results: of the 17 health facilities assessed, only 6 (35.3%) have constituted a palliative care team but only 3 (17.6%) had some sources of fund for PC. Twelve (70.6%) provided nutritional support for PLWHA, 6 (35.3%) provided spiritual and 8 (47.1%) offered bereavement support for families of PLWHA. Sixteen (94.1%) had well-established referral services for PLWHA., Conclusion: palliative care services for PLWHA were generally poor in all the health facilities. There exists a well-established referral services for PLWHA in most of the health facilities. We recommend that the PC structure for PLWHA should be improved by increasing and ensuring compliance to guidelines and the established referral network should continue to be strengthened., Competing Interests: The authors declare no competing interests., (Copyright: Whenayon Simeon Ajisegiri et al.)

Nigeria, with a population of over 190 million people, is rated among the 10 countries with the highest burden of infectious and zoonotic diseases globally. In Nigeria, there exist a sub-optimal surveillance system to monitor and track priority zoonoses. We therefore conducted a prioritization of zoonotic diseases for the first time in Nigeria to guide prevention and control efforts. Towards this, a two-day in-country consultative meeting involving experts from the human, animal, and environmental health backgrounds prioritized zoonotic diseases using a modified semi-quantitative One Health Zoonotic Disease Prioritization tool in July 2017. Overall, 36 of 52 previously selected zoonoses were identified for prioritization. Five selection criteria were used to arrive at the relative importance of prioritized diseases based on their weighted score. Overall, this zoonotic disease prioritization process marks the first major step of bringing together experts from the human-animal-environment health spectrum in Nigeria. Importantly, the country ranked rabies, avian influenza, Ebola Virus Disease, swine influenza and anthrax as the first five priority zoonoses in Nigeria. Finally, this One Health approach to prioritizing important zoonoses is a step that will help to guide future tracking and monitoring of diseases of grave public health importance in Nigeria., Competing Interests: 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., (© 2021 Published by Elsevier B.V.)

Understanding domestic dog population dynamics and ecology is crucial to any effective rabies control program. This study was conducted as part of the baseline epidemiological studies necessary for the establishment of the Kwara Rabies Rapid Alert System "KRRAS". This study aimed to determine the dog population structure of Kwara State by assessing the dog ownership, vaccination status, and prevalence of dog bites. A total of 1460 questionnaires were administered to respondents in the three senatorial zones of the state using Open Data Kit (ODK) between June 2019 to January 2020. Of the 1460 households surveyed, 293 (20.1 %) owned at least one dog with an average of 2.25 dogs per household. The male to female ratio was 1.9:1 and 79.3 % (n = 523/659) of the owned dogs were local breeds. A total of 785 dogs was enumerated (659 dogs from 293 households and 126 free-roaming dogs) and 7811 persons which resulted in a dog-human ratio of 1:9.95. The estimated dog population is 376,789 (95 % CI: 343,700 - 379,878). Only 31 % (n = 204/659) of households vaccinated their dogs against rabies. The prevalence of dog-bite was 13 % (n = 193/1460) of which only 27 % of the victims (n = 61/225) received post-exposure prophylaxis (PEP). Dog ownership was significantly impacted by the ethnicity of respondents. Hausa (OR: 3.76; 95 % CI: 1.15-12.4; p < 0.001) and Nupe (OR: 4.48; 95 % CI: 1.77-11.33; p < 0.001) respondents owned dogs than Yoruba respondents. The rabies vaccination status of owned dogs was significantly impacted by the level of education (OR: 5.03; 95 % CI: 1.50-16.83; p < 0.001); history of previous dog bite incidents (OR: 1.74; 95 % CI: 0.95-3.17; p < 0.001); the breed of the dog with exotic dogs being more vaccinated (OR: 2.79: 95 % 0.64-12.05; p < 0.001). Similarly, Male dogs (OR: 1.49, 95 % 1.03-2.86; p < 0.001) and partially confined dogs (OR: 1.09, 95 % 0.45-2.11, p < 0.001) were found to be vaccinated against rabies. The results of the study showed low dog vaccination coverage, and high number of free roaming dogs. Hence, a threat to public health. The low dog vaccination coverage is below the 70-80 % target recommended for herd immunity by the World Health Organization., (Copyright © 2021. Published by Elsevier B.V.)

Introduction: the current pandemic of coronavirus disease (COVID-19) caused by a novel strain (SARS-CoV-2) is enormous and continues to pose a threat to the lives of people. In Nigeria, as of 21 st April 2020, 668 confirmed cases, 22 deaths and 188 recoveries have been reported. Police officers are at the forefront of enforcing advisories to ensure public compliance. However, there is a paucity of data on knowledge, risk perception, and adherence to COVID-19 advisories issued by the Health authorities particularly among the police officers. We, therefore, assessed the knowledge, risk perceptions and adherence to NCDC recommended advisory on COVID-19., Methods: we conducted a two-stage sampling cross-sectional study among different cadres of police officers in Benue State, Nigeria using a pretested, semi-structured, interviewer-administered questionnaire. The results of the study were presented in frequencies and proportions. Chi-square test was used for an association between variables at p-value < 0.05., Results: the mean age of the 305 participants was 39.1 ± 8.4 years and most, 124 (40.7%) of the participants were within age-group 30-39 years, 19 (64.3%.8) were male, 250 (82.0%) were married and 160 (52.5%) had secondary education as the highest qualification. Majority of the participants, 301 (98.7%) have heard about COVID-19 and the commonest source of information was via television/radio, 230 (76.4%). Most participants demonstrate a good knowledge of COVID-19 infection, 302 (99.0%) and positive risk perception of COVID-19, 303 (99.3%) but few demonstrated good adherences on COVID-19 prevention practices, 133 (43.6%). Participants' academic qualification (X 2 = 10.98, p = 0.001) and cadre (X 2 = 112.5, p = 0.001) were found to be associated with good adherence., Conclusion: while most participants had a good knowledge of COVID-19 transmission dynamics, and positive risk perception about COVID-19, good adherence to public health advisories were low. We recommended periodic training, provision of adequate PPE and personal hand-sanitizers as a strategy to improve adherence., Competing Interests: The authors declare no competing interests., (Copyright: Ubong Akpan Okon et al.)

Introduction: The global tobacco epidemic contributes to more than 8 million deaths annually. However, most tobacco control interventions have been driven by an emphasis on smoked tobacco. Globally and more so in Nigeria, less attention has been paid to the similarly harmful smokeless tobacco (SLT) whose use appeals to a different demography. We examined the prevalence, patterns of use and correlates of SLT in Nigerian adults to guide targeted control efforts., Methods: We conducted a secondary analysis of the 2012 Global Adult Tobacco Survey (GATS) data. We obtained data on 9,765 non-institutionalised adults aged 15 years and older. Variables included current SLT use, sociodemographic characteristics and perceived harm of SLT use. We used Chi-square test to examine associations and binary logistic regression to assess predictors of current SLT use. All analyses were conducted with sample-weighted data., Results: The prevalence of current SLT use was 1.9% of all adults. About 1.4% were daily users. The main types were snuff by nose (1.6%) and snuff by mouth (0.8%). There were higher odds of current SLT use for those in the South-East region (aOR = 13.99; 95% CI: 4.45-43.95), rural area residents (aOR = 1.56; 95% CI: 1.04-2.35), males (aOR = 4.43; 95% CI: 2.75-7.11), the 45-64 years age-group (aOR = 10.00; 95% CI: 4.12-24.29), those with no formal education (aOR = 2.67; 95% CI: 1.01-7.05), and those with no perception of harm from SLT use (aOR = 3.81, 95% CI: 2.61-5.56)., Conclusion: The prevalence of SLT use among Nigerian adults was low with clearly identified predictors. While a majority were aware of harm from SLT use, an unacceptably high proportion remain unaware. We recommended targeted interventions to increase awareness of the harmful effects of SLT use especially among residents of the South-East, those in rural areas, males, and individuals with no formal education. We also recommended a follow-up survey., Competing Interests: The authors have declared that no competing interests exist.

The ability to prevent, promptly detect, and appropriately respond to a public health threat is essential for health security. Field epidemiology training has helped increase the quality and quantity of the public health workforce to strengthen disease surveillance, outbreak preparedness and response, and general public health capacity. We conducted a desk review on the status of the Field Epidemiology and Laboratory Training Program model in 16 countries in West Africa. We also developed a questionnaire and shared it with West African Health Organization (WAHO) member states to document their experiences and the status of training in their countries. WAHO organized a regional 3-day consultative meeting with major stakeholders in the region to examine progress, gaps, and challenges, and outline a roadmap to strengthen the Field Epidemiology and Laboratory Training Program. Stakeholders shared their experiences, engaged in discussions to identify strengths and gaps, and made plans on a way forward. Member states are at different levels of implementing field epidemiology and laboratory training programs in their countries, and, therefore, major gaps remain in the number and distribution of trained epidemiologists throughout West Africa. Member states implement different variants of the program and in some instances the same cadre of health workers are trained in different but comparable programs with different funding streams. Two member states had not begun implementing the training program. Developing regional centers of excellence was recommended in the long term while collaboration among member states to train the required number of epidemiologists to fill the acute needs could be helpful in the short and medium term. Curriculum harmonization and expansion, deployment and use of trained epidemiologists, accreditation of training institutions, and generation of indigenous funding streams are recommended to improve the Field Epidemiology and Laboratory Training Program in West Africa.

Introduction: The novel coronavirus (COVID-19) pandemic has overwhelmed health systems globally. Healthcare workers (HCWs) are faced with numerous challenges during the COVID-19 response. In this study, we aimed to describe the experiences of HCWs during the COVID-19 outbreak in Lagos, Nigeria., Methods: We conducted a qualitative study on the experiences of frontline HCWs at the COVID-19 isolation centers in Lagos, Nigeria using purposive and snowballing sampling techniques. An in-depth interview which lasted for 25-40 minutes for each respondent was conducted among ten medical officers and four nurses between 15 th June and 13 th July 2020. We analyzed data using Colaizzi's phenomenological method., Results: Respondents' age ranged between 29 and 51 years with a median age of 36.5 years. Four themes were identified from data analysis. In the first theme, "COVID-19 care: A call to responsibility", HCWs expressed optimism regarding COVID-19 care, and described the work conditions at COVID-19 isolation centers. In the second theme, "Challenges encountered while caring for COVID-19 patients - coping strategies", HCWs experienced difficulties working in a new environment and with limited resources. They however coped through the available support systems. Regarding the "Experiences in COVID-19 care", the feelings of HCWs varied from pleasure on patients' recovery to distress following patients' demise. On the "Necessities in COVID-19 care", HCWs identified the need for increased psychosocial support, and adequate provision of material and financial support., Conclusions: HCWs at COVID-19 isolation centers need to be assured of a safe working environment while providing them with a strengthened support system., Competing Interests: Conflicts of interest: All authors – none to declare., (GERMS.)

Snakebite envenoming is a public health problem among rural communities in Nigeria. In June, 2016, an outbreak of snakebites in Donga Local Government Area, Taraba State, north-east Nigeria, was reported. We investigated the outbreak to identify risk factors for snakebites and to institute appropriate control measures. We conducted an unmatched case control study to identify risk factors for snakebite in the communities involved. We conducted key informant interviews and Focus Group Discussions with stakeholders in the communities to obtain information on the community´s perspective of the outbreak. There were Sixty-one (61) snakebite cases with Fifteen (15) deaths [CFR 24.6%]. Majority of the mortalities [37(60.3%)] were males. Median age was 27 years (Range: 5-58). Kadarko ward had the highest [26 (42.6%)] number of cases. Most snakebites 12 (44.4%) occurred in the farm, 27 (96.4%) vipers Echis spp were responsible for most of the bite and most [26 (92.9%)] victims sought care from traditional healers. Residing in Kadarko ward and having a history of snakebite in the past were risk factors [Odds ratio of 2.9 (95% CI 1.1-7.4) and 5.9 (95% CI 1.1-32.5)] respectively. Abandonment of homes for two years due to communal clashes has been thought to have allowed snake populations to grow. The snakebite outbreak in Donga, Taraba State affected predominantly male farmers in the rural wards. Residing in Kadarko ward and having a previous history of snakebite were risk factors., Competing Interests: The authors declare no competing interests., (Copyright: Philip Bobu Igawe et al.)

Introduction: every year in Nigeria 12,695 babies are born with neural tube defects. Folic acid reduces the risk of neural tube defect by about 50% among peri-conceptional users. We conducted this study to determine the awareness and use of folic acid among women of childbearing age in Benue State, Nigeria., Methods: we conducted a cross-sectional study among women attending selected among six secondary health facilities in Benue State using a multi-stage sampling technique. We interviewed 586 women aged 15-49 years using structured questionnaires to obtain information on awareness and use of folic acid. We performed univariate, bivariate and multivariate analysis at 5% significance., Results: interviewed 586 women with the mean age 27 ± 6.9 years; 281(48%) were aware of folic acid as a supplement, 178 (30.4%) knew the dietary source of folic acid while 152 (26%) knew the benefit of folic acid. The commonest source of information was health professionals [195 (51%)]. Only 221 (37.7%) used folic acid, 14 (1.7%) of them using it within the first trimester. The commonest reason why women did not take folic acid as supplement was unpleasant smell [124 (21%)]. Awareness of folic acid benefit (OR: 6, 95%CI = 3.9-8.8), level of education (OR: 2.0, 95%CI = 1.2-3.3) and employment status (OR: 1.6, 95%CI= 1.1-22) were significantly associated with folic acid use. Awareness of folic acid use was an independent predictor of folic acid use (AOR: 7.9 95%Cl: 5.3-11.7)., Conclusion: awareness and use of folic acid among women of childbearing age was low. Awareness is a predictor of folic acid use. We recommend the promotion of awareness and use of folic acid in pregnant women., Competing Interests: The authors declare no competing of interests., (Copyright: Ubong Akpan Okon et al.)