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International audience; BackgroundThe COVID-19 pandemic led to severe health systems collapse, as well as logistics and supply delivery shortages across sectors. Delivery of PCR related healthcare supplies continue to be hindered. There is the need for a rapid and accessible SARS-CoV-2 molecular detection method in low resource settings.ObjectivesTo validate a novel isothermal amplification method for rapid detection of SARS-CoV-2 across seven sub-Sharan African countries.Study designIn this multi-country phase 2 diagnostic study, 3,231 clinical samples in seven African sites were tested with two reverse transcription Recombinase-Aided Amplification (RT-RAA) assays (based on SARS-CoV-2 Nucleocapsid (N) gene and RNA-dependent RNA polymerase (RdRP) gene). The test was performed in a mobile suitcase laboratory within 15 min. All results were compared to a real-time RT-PCR assay. Extraction kits based on silica gel or magnetic beads were applied.ResultsFour sites demonstrated good to excellent agreement, while three sites showed fair to moderate results. The RdRP gene assay exhibited an overall PPV of 0.92 and a NPV of 0.88. The N gene assay exhibited an overall PPV of 0.93 and a NPV 0.88. The sensitivity of both RT-RAA assays varied depending on the sample Ct values. When comparing sensitivity between sites, values differed considerably. For high viral load samples, the RT-RAA assay sensitivity ranges were between 60.5 and 100% (RdRP assay) and 25 and 98.6 (N assay).ConclusionOverall, the RdRP based RT-RAA test showed the best assay accuracy. This study highlights the challenges of implementing rapid molecular assays in field conditions. Factors that are important for successful deployment across countries include the implementation of standardized operation procedures, in-person continuous training for staff, and enhanced quality control measures.

Background: Data regarding the features and outcomes of hospitalized COVID-19 patients in Africa are increasingly available. Objectives: To describe socio-demographic, clinical and laboratory characteristics and outcomes of COVID-19 patients. Methods: A cross-sectional study of 86 adult patients hospitalized with COVID-19 between March and November 2020. Characteristics were described in survivors and non-survivors. Results: Mean age was 60.9±16.1 years, 53(61.6%) were male. Co-morbidities were found in 77(89.5%) patients. On severity, 6(7%) were mild, 23(26.7%) moderate, 51(59.3%) severe and 6(7%) critical. Oxygen saturation and respiratory rate were 71±22% and 38±11/minute in non-survivors and 90±7% and 31±7/minute in survivors respectively (p

Purpose: In the critically ill, hospital-acquired bloodstream infections (HA-BSI) are associated with significant mortality. Granular data are required for optimizing management, and developing guidelines and clinical trials. Methods: We carried out a prospective international cohort study of adult patients (≥ 18years of age) with HA-BSI treated in intensive care units (ICUs) between June 2019 and February 2021. Results: 2600 patients from 333 ICUs in 52 countries were included. 78% HA-BSI were ICU-acquired. Median Sequential Organ Failure Assessment (SOFA) score was 8 [IQR 5; 11] at HA-BSI diagnosis. Most frequent sources of infection included pneumonia (26.7%) and intravascular catheters (26.4%). Most frequent pathogens were Gram-negative bacteria (59.0%), predominantly Klebsiella spp. (27.9%), Acinetobacter spp. (20.3%), Escherichia coli (15.8%), and Pseudomonas spp. (14.3%). Carbapenem resistance was present in 37.8%, 84.6%, 7.4%, and 33.2%, respectively. Difficult-to-treat resistance (DTR) waspresent in 23.5% and pan-drug resistance in 1.5%. Antimicrobial therapy was deemed adequate within 24h for 51.5%. Antimicrobial resistance was associated with longer delays to adequate antimicrobial therapy. Source control was needed in 52.5% but not achieved in 18.2%. Mortality was 37.1%, and only 16.1% had been discharged alivefrom hospital by day-28. Conclusions: HA-BSI was frequently caused by Gram-negative, carbapenem-resistant and DTR pathogens. Antimicrobial resistance led to delays in adequate antimicrobial therapy. Mortality was high, and at day-28 only a minority of the patients were discharged alive from the hospital. Prevention of antimicrobial resistance and focusing on adequate antimicrobial therapy and source control are important to optimize patient management and outcomes.

Identifying the dissemination patterns and impacts of a virus of economic or health importance during a pandemic is crucial, as it informs the public on policies for containment in order to reduce the spread of the virus. In this study, we integrated genomic and travel data to investigate the emergence and spread of the B.1.1.318 and B.1.525 variants of interest in Nigeria and the wider Africa region. By integrating travel data and phylogeographic reconstructions, we find that these two variants that arose during the second wave emerged from within Africa, with the B.1.525 from Nigeria, and then spread to other parts of the world. Our results show how regional connectivity in downsampled regions like Africa can often influence virus transmissions between neighbouring countries. Our findings demonstrate the power of genomic analysis when combined with mobility and epidemiological data to identify the drivers of transmission in the region, generating actionable information for public health decision makers in the region.

Background Reports on the evaluation of immune responses to different COVID-19 vaccines are limited. Similarly, effects of age and gender have not been well explored as variables that could impact on the vaccine-induced antibody response. Therefore, seroprevalence of anti-SARS-CoV-2 specific antibodies in vaccinated and vaccine naïve adult Nigerians was determined in this study. Methodology A total of 141 adults were enrolled into this study. Presence or absence of SARS-CoV-2 infection was confirmed by real-time reverse-transcriptase polymerase-chain reaction (RT-PCR) assay on nasopharyngeal and oropharyngeal swab specimens. Anti-SARS-CoV-2 Specific IgG and IgM antibodies were qualitatively detected using a Rapid Diagnostic Test kit. Results Pre-vaccination, 77% of the study participants had never had PCR-confirmed COVID-19 test yet 66.7% of them were seropositive for SARS-CoV-2 antibodies. Of 111 COVID-19 vaccinated participants, 69.2% and 73.8% of them had SARS-CoV-2 specific IgG post-first and second doses of COVID-19 vaccine respectively. However, 23.1% and 21.4% of the participants who have had first and second doses respectively had no detectable anti-SARS-CoV-2 antibodies. The proportion of participants with SARS-CoV-2 specific IgG was insignificantly higher in those between the ages of 18–40 years and 41–59 years compared with individuals aged ≥60 years. No significant association was observed between gender and seropositivity for SARS-CoV-2 antibodies. Conclusion There is high SARS-CoV-2 antibody seroprevalence among Nigerian adults who never had PCR-confirmed COVID-19. Also, there is the need for anti-SARS-CoV-2 antibodies screening post vaccination as this could be essential in achieving herd immunity. Age and gender do not seem to have significant association with seropositivity.

Hepatitis B virus (HBV) infection is a major health challenge in sub-Saharan Africa with a prevalence rate of7%. It is an important clinical problem due to its potential adverse sequelae, including hepatocellular carcinoma. The additional challenge of its associated chronic infection makes its prevention difficult despite the widely available vaccine. Infectious chronic HBV carriers are likely to be the most common source of HBV infection in the community. This study aims to study the degree of infectiousness of HBV carriers by testing for HBV envelope antigen (HBeAg) and antibody among HBV carriers attending the gastrointestinal clinic at University College Hospital (UCH, Ibadan, Nigeria). This is a cross-sectional study among 129 consecutively recruited HBV infected individuals who gave informed consent to participate in the study. The participants of the study were recruited from clients attending the gastrointestinal clinic of UCH. The sera obtained from the participants were tested for HBsAg, HBeAg, and antibodies to HBV envelope antibodies (HBeAb) using commercially available enzyme-linked immunosorbent assay (ELISA) test kits by DIA.PRO (Diagnostic Bioprobes Srl, Milan, Italy) according to the manufacturer's instruction. Of 129 samples collected, 63 (48.8%) tested positive for HBeAg, whereas 72 (55.8%) tested positive for HBeAb (

Background: Nigeria joined the global community in monitoring antimicrobial prescribing practices since 2015. Results of individual hospital Global Point Prevalence Survey (Global-PPS) have stimulated efforts at instituting hospital-based antimicrobial stewardship (AMS) programmes. We report the trends of antimicrobial prescribing rates and quality indicators for 3 surveillance periods; 2015, 2017 and 2018.Methodology: The web-based Global-PPS for surveillance of antimicrobial use in hospitals (www.globalpps.com) was completed by each participating hospital site for all inpatients receiving antimicrobials on a selected day in 2015, 2017 and 2018. Data included details on antimicrobial agents, reasons and indications for treatment and a set of quality prescribing indicators. Data were validated by the web-based data management system of University of Antwerp, exported into Microsoft Excel and analyzed with EPI INFO version 7.2.Results: Thirteen hospitals participated in the survey involving a total of 5,174 inpatients. Mean weighted overall antimicrobial prescribing prevalence was 70.7% which declined over the years from 71.7% in 2015 to 59.1% in 2018 (p

Background: IgG antibodies may serve as promising targets to detect and evaluate immune responses against the SARS-CoV-2 virus. Both IgA and IgM antibodies target the spike protein’s receptor binding domain and are rapidly decayed, while IgG antibodies remain relatively stable for longer periods in COVID-19 patients. Objectives: The current study was designed to detect the presence of SARS-CoV-2 antibodies among convalescent COVID-19 patients and to evaluate the relationship between these antibodies, the symptom grade and their baseline Cycle Threshold (CT) by RT-PCR. Methods: Eighty-nine convalescent COVID-19 patients on admission were recruited and tested until negative by RT-PCR. Sera obtained from participants were screened for SARS-CoV-2 IgM and IgG antibodies using rapid lateral flow assays. Results: It was observed that 93,3% and 77,5% respectively had IgM and IgG antibodies against the S1 protein of SARS-CoV-2. Majority (74,0%) presented with mild COVID-19 symptoms with a mean RT-PCR Ct value of 31,4. Conclusion: Convalescent COVID-19 patients develop a fairly good level of IgG antibodies. The antibody status is not dependent on CT value or symptom grade. However, there was a significant correlation between baseline CT and time taken to test negative by RT-PCR.

Background: As part of our contribution to the growing pool of knowledge on the prevention and control of the COVID-19 pandemic, this study describes the demographic features of patients with COVID-19 hospitalized at Infectious Disease Center (IDC), Olodo, Ibadan, Oyo State, Nigeria.Methodology: This was a descriptive cross-sectional study of COVID-19 patients whose data were collected during admission between April 27, 2020 and June 20, 2020. SARS-CoV-2 infection was diagnosed on nasopharyngeal specimen using a real-time reverse transcription–polymerase chain reaction (rRT-PCR) assay. Data were analysed using the Statistical Package for Social Sciences (SPSS Inc., USA) version 20.0Results: Among 131 patients, 58% were between age 18 and 35 years, 48.1% were employees of private establishments, and 64.1% were males. High proportion (84.3%) of the patients spent less than 14 days on admission. As at June 20, 2020, the overall COVID-19 mortality in the IDC was 0.0%.Conclusion: This study concluded that COVID-19 was common among male Nigerians, those working in private establishments, and those aged 18-35 years. Future researches on COVID-19 in Nigeria must put gender and age into consideration. Keywords: SARS-COV2; COVID-19; age; gender; occupation French Title: Attributs démographiques des patients atteints de COVID-19dans un centre de maladies infectieuses du Nigéria Contexte: Dans le cadre de notre contribution au pool croissant de connaissances sur la prévention et le contrôle de la pandémie COVID-19, cette étude décrit les caractéristiques démographiques des patients atteints de COVID19 hospitalisés au Centre des maladies infectieuses (IDC), Olodo, Ibadan, État d'Oyo, Nigéria. Méthodologie: Il s'agissait d'une étude transversale descriptive de patients atteints de COVID-19 dont lesdonnées ont été collectées lors de l'admission entre le 27 avril 2020 et le 20 juin 2020. L'infection par le SRASCoV-2 a été diagnostiquée sur un échantillon nasopharyngé à l'aide d'une transcription inverse en temps réel–Test de réaction en chaîne par polymérase (rRT-PCR). Les données ont été analysées à l'aide du StatisticalPackage for Social Sciences (SPSS Inc., USA) version 20.0 Résultats: Parmi 131 patients, 58% avaient entre 18 et 35 ans, 48,1% étaient des employés d'établissementsprivés et 64,1% étaient des hommes. Une forte proportion (84,3%) des patients ont passé moins de 14 jours àl'admission. Au 20 juin 2020, la mortalité globale par COVID-19 dans l'IDC était de 0,0%. Conclusion: Cette étude a conclu que le COVID-19 était courant chez les hommes Nigérians, ceux travaillantdans des établissements privés et ceux âgés de 18 à 35 ans. Les futures recherches sur le COVID-19 au Nigériadoivent prendre en compte le sexe et l'âge. Mots clés: SRAS-COV2; COVID-19; âge; le sexe; occupation

Background: Hepatitis B virus infection is one of the greatest threats to blood safety all over the world. The laboratory algorithm based on only the detection of hepatitis B surface antigen (HBsAg) leaves a gap for infected HBsAg negative donors to donate blood during the “window period” (WP) and late stages of infection. Objective: To estimate the frequency of the presence of HBV deoxyribonucleic acid (DNA) in HBsAg negative blood units screened using two different assays for HBsAg in a high endemic region. Methods: Frozen serum aliquot of 100 replacement blood donors who donated blood units that were HBsAg negative were retrieved and tested for HBV DNA. Sample positive for HBV DNA was sequenced by Sanger’s method, genotyped and the viral load was determined. Results: One sample (1%) was positive for HBV DNA. The HBV viral load of the sample was 768,000 IU/ml. The partial S-gene of the Hepatitis B virus isolated was genotype E using the NCBI viral genotyping tool. Conclusions: There is still a risk of HBV infected blood unit escaping detection when donor testing is limited to HBsAg screening. The use of NAT which can substantially reduce HBV infected blood donors from the donor pool should be considered. Keywords: Hepatitis B surface Antigen; Hepatitis B Virus; DNA; blood donors; blood safety.

SummaryBackgroundFinding effective therapeutics for COVID-19 continues to be an urgent need, especially considering use context limitations and high cost of currently approved agents. The NACOVID trial investigated the efficacy and safety of repurposed antiprotozoal and antiretroviral drugs, nitazoxanide and atazanavir/ritonavir, used in combination for COVID-19.MethodsIn this pilot, randomized, open-label trial conducted in Nigeria, patients diagnosed with mild to moderate COVID-19 were randomly assigned to receive standard of care (SoC) or SoC plus a 14-day course of nitazoxanide (1000 mg b.i.d.) and atazanavir/ritonavir (300/100 mg od) and followed through day 28. Study endpoints included time to clinical improvement, SARS-CoV-2 viral load change, and time to complete symptom resolution. Safety and pharmacokinetics of nitazoxanide active metabolite, tizoxanide, were also evaluated. This trial was registered withClinicalTrials.gov(NCT04459286).FindingsThere was no difference in time to clinical improvement between the SoC (n = 26) and SoC plus intervention arms (n = 31; Cox proportional hazards regression analysis adjusted hazard ratio, aHR = 0.898, 95% CI: 0.492-1.638, p = 0.725). No difference was observed in the pattern of saliva SARS-CoV-2 viral load changes from days 2 to 28 in the 35% of patients with detectable virus at baseline (20/57) between the two arms (aHR = 0.948, 95% CI: 0.341-2.636, p = 0.919). There was no significant difference in time from enrolment to complete symptom resolution (aHR = 0.535, 95% CI: 0.251 - 1.140, p = 0.105). Atazanavir/ritonavir increased tizoxanide plasma exposure by 68% and median trough plasma concentration was 1546 ng/ml (95% CI: 797-2557), above its putative EC90in 54% of patients. Tizoxanide was not detectable in saliva.InterpretationThese findings should be interpreted in the context of incomplete enrolment (64%) and the limited number of patients with detectable SARS-CoV-2 in saliva at baseline in this trial.FundingThe University of Liverpool.Research in contextEvidence before this studyThe potential efficacy of nitazoxanide as a repurposed drug for COVID-19 is being investigated in a number of studies due to confirmedin vitroactivity against SARS-CoV-2. Available data from completed randomised controlled trials in which clinical improvement, effect on viral load, and symptom resolution were evaluated as outcomes do not offer conclusive evidence.Added value of this studyIn the NACOVID trial, we sought to take advantage of a model-informed strategy and known interaction between nitazoxanide and atazanavir/ritonavir to achieve optimal concentration of tizoxanide in plasma, and possibly in respiratory tracts of patients with mild to moderate COVID-19. While this strategy significantly enhanced tizoxanide exposure in the plasma of patients, our data indicated poor penetration into the respiratory tracts. Specifically, there were no differences in time to clinical improvement, viral load changes, and symptom resolutions between patients who were given standard of care alone and those who combined it with study intervention.Implications of all the available evidenceThe clinical benefit of nitazoxanide remains uncertain. The present study highlights the need for early insight into target site biodistribution of potential COVID-19 therapeutics to better inform candidate selection for clinical trials.

The spread of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), has resulted in a global pandemic that has claimed the lives of millions of people. Genomic surveillance of the virus has proven to be a critical tool for tracking the emergence and spread of variants with increased transmission or immune evasion potential. Despite the global distribution of infection, differences in viral genomic surveillance capabilities between countries and regions have resulted in gaps in our understanding of the viral population dynamics underlying the pandemic. Nigeria, despite having the largest population of any country in Africa, has had relatively little SARS-CoV-2 sequence data made publicly available. In this study, we report the whole-genome sequences of 74 SARS-CoV-2 isolates collected from individuals in Oyo State, Nigeria over the first two weeks of January 2021. Forty-six of the isolates belong to the B.1.1.7 "UK variant" lineage. Comparison to available regional and global sequences suggest that the B.1.1.7 isolates in Nigeria are primarily monophyletic, possibly representing a singular successful introduction into the country. The majority of the remaining isolates (17 of 74) belong to the B.1.525 lineage, which contains multiple spike protein mutations, including the E484K mutation associated with potential immune escape. Indeed, Nigeria has the highest reported frequency of this lineage despite its relative rarity worldwide. Phylogenetic analysis of the B.1.525 isolates in this study relative to other local and global isolates suggested a recent origin and rapid expansion of this lineage in Nigeria, with the country serving as a potential source for this lineage in other outbreaks. These results demonstrate the importance of genomic surveillance for identifying SARS-CoV-2 variants of concern in Nigeria and in other undersampled regions across the globe.

Background and objectives Reports on the association of the ABO phenotypes with infection by the SARS‐CoV‐2 virus have mostly come from countries with high infection rates. This study examined the possible association between SARS‐CoV‐2 infection and the ABO phenotype in Black Africa. Materials and methods This report is from a single centre where both asymptomatic and symptomatic patients were quarantined. At the time of this report, Oyo State, Nigeria had carried out 15 733 tests of which 3119 were positive for the virus with 1952 recoveries and 37 deaths. The ABO distribution of patients was compared with that of a blood donor population. Results Of the 302 participants, 297 (98%) had their blood group determined, asymptomatic and symptomatic individuals were 123 (40·7%) and 179 (59·3%) respectively. Blood group O was significantly less represented among the patients (P

COVID-19 caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) enters the host cells through attachment to the Angiotensin Converting Enzyme-2 receptors (ACE-2) on the host cells. ACE-2 is known to affect renal functions, vasoconstriction and fluid homeostasis. Thus, the impact of SARS-CoV-2 infection on renal functional parameters is worth investigating. Plasma obtained from whole blood samples collected from newly diagnosed COVID-19 patients were analysed for albumin, urea, creatinine, Na, K, Cl and HCO3 using auto analysers. All newly diagnosed patients were immediately admitted for managed at the Infectious Disease Center, Olodo in Ibadan the capital of Oyo State, South Western Nigeria. The results obtained were evaluated to determine the frequency of derangements in the renal parameters of patients with the COVID-19 disease. It was observed that 57.1%, 37.8%, 32.7%, 28.1%, 18.7%, 17.8% and 3.4% of newly diagnosed COVID-19 patients had values of Cl, creatinine, albumin, Na, K, HCO3 and urea respectively outside the reference ranges. While 43.3%, 4.7%, 2.5%, 2.5%, 2.0%, 1.7% and 1.0% of COVID-19 patients had values of Cl, creatinine, Na, K, albumin, Urea and HCO3 respectively above the reference ranges. Of all admitted patients, 33.1%, 30.7%, 25.6%, 16.8%, 16.3%, 13.8% and 1.7% had creatinine, albumin, Na, HCO3, K, Cl and urea values respectively below reference ranges. The changes in renal function parameters of newly diagnosed COVID-19 patients portend that renal failure is imminent in poorly managed COVID-19 patients and this has immunopathology implications during SAR-COV-2 infection.

Objectives To investigate the efficacy and safety of repurposed antiprotozoal and antiretroviral drugs, nitazoxanide and atazanavir/ritonavir, in shortening the time to clinical improvement and achievement of SARS-CoV-2 polymerase chain reaction (PCR) negativity in patients diagnosed with moderate to severe COVID-19. Trial design This is a pilot phase 2, multicentre 2-arm (1:1 ratio) open-label randomised controlled trial. Participants Patients with confirmed COVID-19 diagnosis (defined as SARS-CoV-2 PCR positive nasopharyngeal swab) will be recruited from four participating isolation and treatment centres in Nigeria: two secondary care facilities (Infectious Diseases Hospital, Olodo, Ibadan, Oyo State and Specialist State Hospital, Asubiaro, Osogbo, Osun State) and two tertiary care facilities (Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State and Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State). These facilities have a combined capacity of 146-bed COVID-19 isolation and treatment ward. Inclusion criteria Confirmation of SARS-CoV-2 infection by PCR test within two days before randomisation and initiation of treatment, age bracket of 18 and 75 years, symptomatic, able to understand study information and willingness to participate. Exclusion criteria include the inability to take orally administered medication or food, known hypersensitivity to any of the study drugs, pregnant or lactating, current or recent (within 24 hours of enrolment) treatment with agents with actual or likely antiviral activity against SARS-CoV-2, concurrent use of agents with known or suspected interaction with study drugs, and requiring mechanical ventilation at screening. Intervention and comparator Participants in the intervention group will receive 1000 mg of nitazoxanide twice daily orally and 300/100 mg of atazanvir/ritonavir once daily orally in addition to standard of care while participants in the control group will receive only standard of care. Standard of care will be determined by the physician at the treatment centre in line with the current guidelines for clinical management of COVID-19 in Nigeria. Main outcome measures Main outcome measures are: (1) Time to clinical improvement (defined as time from randomisation to either an improvement of two points on a 10-category ordinal scale (developed by the WHO Working Group on the Clinical Characterisation and Management of COVID-19 infection) or discharge from the hospital, whichever came first); (2) Proportion of participants with SARS-CoV-2 polymerase chain reaction (PCR) negative result at days 2, 4, 6, 7, 14 and 28; (3) Temporal patterns of SARS-CoV-2 viral load on days 2, 4, 6, 7, 14 and 28 quantified by RT-PCR from saliva of patients receiving standard of care alone versus standard of care plus study drugs. Randomisation Allocation of participants to study arm is randomised within each site with a ratio 1:1 based on randomisation sequences generated centrally at Obafemi Awolowo University. The model was implemented in REDCap and includes stratification by age, gender, viral load at diagnosis and presence of relevant comorbidities. Blinding None, this is an open-label trial. Number to be randomised (sample size) 98 patients (49 per arm). Trial status Regulatory approval was issued by the National Agency for Food and Drug Administration and Control on 06 October 2020 (protocol version number is 2.1 dated 06 August 2020). Recruitment started on 9 October 2020 and is anticipated to end before April 2021. Trial registration The trial has been registered on ClinicalTrials.gov (July 7, 2020), with identifier number NCT04459286 and on Pan African Clinical Trials Registry (August 13, 2020), with identifier number PACTR202008855701534. Full protocol The full protocol is attached as an additional file which will be made available on the trial website. In the interest of expediting dissemination of this material, the traditional formatting has been eliminated, and this letter serves as a summary of the key elements in the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines (Additional file 2).

INTRODUCTION: Antibiotic overprescribing is associated with antibiotic resistance worldwide but worst in developing nations. Minimal information exists on the antibiotic prescribing habits of essentially all cadres of healthcare workers in Nigeria, but particularly primary healthcare (PHC) workers. Our aim was to explore antibiotic prescribing habits of Nigerian primary healthcare workers in the context of increasing antibiotic resistance which has a direct effect on healthcare associated infections (HCAIs) and patient safety worldwide. METHODS: a questionnaire-based cross-sectional study was conducted among 442 primary healthcare workers across three Northern Nigerian states of Gombe, Sokoto and Kwara. Data obtained was analysed using SPSS version 20. RESULTS: antibiotic prescription rate was 98.2%. The most commonly prescribed antibiotics were amoxicillin (71.7%) and ampicillin/cloxacillin (70.1%) while the least was meropenem (4.1%). Major indicators of antibiotics abuse include unconfirmed typhoid fever (96.1%), non-specific vaginal discharge (95.4%), fresh trauma wound (91.3%), non-specific diarrhoea (87.1%) and common cold (85.9%). Additionally, about one-third of the respondents also routinely prescribe antibiotics to healthy birds (31.5%) and animals (18.3%). Identified reasons attributed to antibiotic overprescribing from the participants´ perspectives include lack of awareness (87.0%), lack of penalty (79.4%), desire to help patients (76.5%), pressure from sales representatives (61.0%) and patients´ pressure (58.3%). Overall, majority (85.8%) of respondents agrees that overprescribing is a cause of antimicrobial resistance. CONCLUSION: overprescribing of antibiotics is common among PHC workers and could contribute significantly to the rising scourge of antimicrobial resistance and poses a threat to patient safety and associated increased burden of HCAIs.

Background: Anti-hepatitis B core antibody (anti-HBc) testing improves transfusion safety by detecting past and current hepatitis B virus (HBV) infection while detecting hepatitis B surface antigen (HBsAg) in serology-negative HBV infection. However, occult HBV infection (OBI) (serum or liver HBV DNA-positive but HBsAg-negative) remains unaddressed among replacement blood donors – family members or friends who donate to replace blood transfused to a relative.Objective: This study assessed risk factors for a positive anti-HBc test among donors with OBI and determined the anti-HBc-positive status of replacement donors.Methods: The study was conducted at the University College Hospital Blood Bank, Ibadan, Nigeria, using blood samples collected from blood donors between April 2019 and May 2019. Donors were screened for HBsAg by rapid diagnostic test (RDT) and enzyme-linked immunosorbent assay (ELISA) and anti-HBc by ELISA, while HBV DNA was detected using a semi-nested polymerase chain reaction.Results: Of the 274 participants, 15 (5.5%) were HBsAg-positive by RDT and 36 (13.1%) by ELISA, while 133 (48.5%) were anti-HBc positive. Out of 232 HBsAg-negative donors, 107 (46.1%) were anti-HBc positive. Of the 107 HBsAg-negative but anti-HBc-positive samples, only one (0.93%) was HBV DNA-positive. The HBV DNA-positive donor was HBsAg-negative by both RDT and ELISA tests.Conclusion: This study establishes a potential risk for HBV transmission from isolated anti-HBc-positive donors to blood recipients. HBc immunoglobulin (antibody) M testing to identify blood units requiring further screening with polymerase chain reaction to detect OBI can prevent HBV transmission through blood transfusion.

The novel COVID-19 pandemic prompted an unprecedented Institutional reaction to aggregate existing capacity from silos of research laboratories to establish a multidisciplinary research laboratory for COVID19 testing. In less than two weeks, resources were mobilized from the community to strengthen public health response and epidemic control. Such strengthening of institutional research capacity to support public health response contributes to a natural knowledge transfer, facilitates collaboration, and generates new frontiers for knowledge production that should ultimately lead to professional development and retention of skilled human resources. This report describes the pre-established mechanisms and involvement of the authors that made it possible to set-up a multidisciplinary laboratory in a remarkably short period of time. We also discuss the opportunities and sustainability of multidisciplinary laboratory research post-COVID19. Existing institutional capacity can be repurposed to establish multidisciplinary research laboratories to support the strengthening of basic and clinical translational research capacity in resource limited settings and impact on public health and scientific knowledge for socioeconomic development.

Introduction: Hepatitis D infection causes severe form of viral hepatitis in humans and only affects those with hepatitis B either as a co-infection or superinfection. The aim of this study was to determine the prevalence of Hepatitis D and its effect on the immunologic and molecular profile of Hepatitis B among asymptomatic Chronic Hepatitis B patients in Abeokuta.Methodology: A cross-sectional study of 99 chronic HBV patient who met the inclusion criteria. All the patients were tested for HBsAg, anti HCV, HDV antigen, anti HDV, HBsAg quantification, and HBV DNA quantification. Associations were tested for and P value less than 0.05 was considered significant.Results: The participants included 53 (58%) male and 38 (42%) females with ages ranging from 18 to 69 (means 39 ± 11) years. Ten (11%) participants were positive for HDV-Ag while 1 (1.1%) was positive for anti-HDV. Five (5.5%) were positive for HIV 1 &2 while 1 (1.1%) was positive for anti HCV. HBV DNA quantification ranged from 15 to 17,000,000 IU/ml while HBsAg quantification ranged from 0.25 to45,520 IU/ml. There was no statistically significant relationship between HDV-Ag and age (p = .51), sex (p = .73), HBV DNA (p = .8) and HBsAg quantification (p = 1).Conclusion: The prevalence of HDV-Ag among asymptomatic treatment naive chronic hepatitis B patients in Abeokuta was 11% and there was no significant difference in the levels of HBV DNA and HBsAg among those with or without hepatitis D.

Pandemics can result in significantly high rates of morbidity and mortality with higher impact in Lower- and Middle-Income Countries like Nigeria. Health systems have an important role in a multi-sector response to pandemics, as there are already concerns that COVID-19 will significantly divert limited health care resources. This study appraised the readiness and resilience of the Nigerian health system to the COVID-19 pandemic, using Oyo State, southwest Nigeria, as a case study. This study was a cross-sectional qualitative study involving key informant and in-depth interviews. Purposive sampling was used in recruiting participants who were members of the Task Force on COVID-19 in the state and Emergency Operations Centre (EOC) members (physicians, nurses, laboratory scientists, “contact tracers”, logistic managers) and other partners. The state's health system response to COVID 19 was assessed using the WHO health systems framework. Audio recordings of the interviews done in English were transcribed and thematic analysis of these transcripts was carried out using NVIVO software. Results show that the state government responded promptly by putting in place measures to address the COVID-19 pandemic. However, the response was not adequate owing to the fact that the health system has already been weakened by various challenges like poor funding of the health system, shortage of human resources and inadequate infrastructure. These contributed to the health system's sub-optimal response to the pandemic. In order to arm the health system for adequate and appropriate response during major health disasters like pandemics, fundamental pillars of the health system-finance, human resources, information and technology, medical equipment and leadership - need to be addressed in order to have a resilient health system.

INTRODUCTION: Persistent high-risk HPV (hrHPV) infection is higher among women living with HIV/AIDS thus increasing their risk for cervical cancer. We evaluated the virological and immunological correlates of cervical dysplasia in HIV-infected women. METHODS: a cohort of 220 consenting women attending the antiretroviral clinic of the Federal Medical Centre, Keffi, Nigeria was tested for cervical human papilloma virus (HPV) infection using PCR. The prevalent HPV genotypes were determined by DNA sequencing. CD4+T count and type specific HPV was correlated with cervical cytology. Descriptive and inferential statistical analysis of the data was done using the statistical package for social sciences (SPSS) version 20 (SPSS Inc, Illinois, USA) for analysis after validation. RESULTS: overall HPV prevalence was 54.1% while the hrHPV prevalence was 35.9%. Premalignant and malignant lesions were observed among participants with CD4+T counts between 200-300/mm3. A statistically significant association was observed between cervical premalignant lesions and CD4+ count (X2 = 24.747, P value = 0.001) as well as hrHPV infections (X2 = 46.800, P < 0.001). CONCLUSION: risk stratification with HPV screening among HIV-infected women will help in early case management of cervical precancerous lesions.

Aim: This study was carried out to determine the prevalence of human T cell lymphotropic virus I/II (HTLV I/II) among blood donors at the Federal Teaching Hospital Gombe (FTHG), North-eastern, Nigeria. Methods: A total of 355 blood donors were recruited at the hematology department of FTHG for a hospital based cross-sectional study and were screened/confirmed for HTLV I/II by ELISA and western blot methods. Results: Seroprevalence of HTLV I/II among the 355 participants with mean age of 30.77 years (±8.27) was 6.5% on screening with ELISA but confirmed to be 0% by western blot. Majority were males, 352 (99.2%) and mostly (45.9%) between 21–30 years of age. Donors for family replacements predominated (85.1%) with more than half (58.6%) being first time blood donors. Conclusion: This study reveals the absence of HTLV I/II among blood donors in Gombe North-eastern Nigeria. It also highlights the possibility of false positivity in some of the reported prevalence of HTLV I and II from some parts of Nigeria that were based on screening tests only. The importance of confirmatory testing in all research works on HTLV (including HTLV 3 and HTLV 4) is further strengthened with this study. There is however the need for a larger study and the use of molecular diagnostics to reconfirm this assertion.

A novel coronavirus 2019 now re-designated coronavirus disease 2019 (COVID-19) virus, emerged in Wuhan, China, on December 2019. Greater details about its origin and basis for high transmissibility remain largely unknown. The increasing incidence possibly linked to human-to-human transmission of the virus has resulted in rapid spread of the disease to 145 countries including Nigeria. To the best of our knowledge, the current review is one of the first locally published information on the novel COVID-19.We hereby describe the etiology, epidemiology, clinical management, and infection prevention and control of practices against COVID-19. This is to create more public awareness and sensitize health-care professionals on the urgent need for early recognition of suspect cases and practice of droplet and contact precautions to curtail the rapid spread of COVID-19.

Monkey pox infection is a zoonotic infection transmitted by direct or indirect contact with blood, body fluids and lesions of an infected animal. Human to human spread of Monkey pox has been described and infection is usually self-limiting, with an incubation period of 6-16 days. In Nigeria, the last case of monkey pox infection was recorded over 46 years ago. The recent emergence in Nigeria occurred in the year 2017 and was reported to have spread to 24 states with 228 suspected individuals affected. Laboratory diagnosis, as well as management and prevention of monkey pox infection in Nigeria, remain challenging as Nigeria is a resource-poor country with limited infrastructure, technical skill and training which is required in making a diagnosis. The ability of the monkey pox virus to evolve, its potential bioterrorism potential, as well as its recent emergence in Nigeria further justifies the need for improving the understanding of the presentation and prevention of monkey pox infection. Keywords: monkey pox, emerging virus, Nigeria, rash, zoonosis, orthopox

Background: Hepatitis E virus (HEV) is one of the causative agent of acute viral hepatitis in humans. HEV is an important public health disease in many parts of the world because it is transmitted faeco-orally. Majority of the documented studies on hepatitis E virus in Nigeria have focused on pregnant women and animal handlers with limited data among food handlers. Thus the current study aimed at investigating the prevalence of HEV infection among food handlers operating within the premises of a tertiary care facility.Methods: One hundred and seventy seven (177) food handlers were screened using commercial Enzyme-Linked Immuno-Sorbent Assay (ELISA) to detect IgM antibodies to Hepatitis E. A semi-structured questionnaire was used to assess risk factors for HEV infection.Results: HEV IgM antibodies were detected in 16 (9.0%) of the participants. Age-specific HEV IgM seroprevalence appeared to decrease with age, however there were no significant differences in HEV IgM seropositivity regarding age (P=0.251), gender (P = 0.231), marital status (P=0.735) and religion (P = 0.906). Significant risk factors for HEV IgM seropositivity included source of water for drinking (P=0.03) and the use of soap for hand washing (P=0.02).Conclusion: Our findings suggest that HEV remains a public health problem, as the virus circulates at low but considerable levels especially among food handlers; thus posing a threat to potential contacts. Proper hand washing practices as well as provision of portable water are important factors for the control of Hepatitis E.

Infection with high-risk genotypes of human papillomavirus (HPV) is considered the main cause of invasive cervical. A number of epidemiologic studies have suggested that HPV and Chlamydia trachomatis (CT) play a synergistic role in the etiology of cervical intraepithelial neoplasia and subsequent cervical cancer. The current study aimed to evaluate the HPV prevalence and the risk factors for co-infection with CT among women attending family planning clinic in Nigeria. Following enrolment, 90 patients were screened for IgG antibodies to virus-like proteins of HPV types 6, 8, 16, and 18. CT seropositivity was tested by enzyme-linked immunosorbent assay for the detection of IgG and IgM antibodies. The prevalence of HPV IgG was 20%. Seropositivity for CT IgM was 77.8% while the IgG was 0%. A total of 10 women (11.1%) were seropositive for both CT IgM and HPV IgG antibodies. Seropositivity for HPV IgG was significantly associated with age at marriage (P 0.001), current Chlamydia infection (P 0.011), and number of children (P 0.025), while seropositivty for HPV IgG and Chlamydia trahomatis IgM was significantly associated with age at coitarche (P 0.028), number of life sex partners (P 0.033), and history of multiple sexual partners (P 0.002).

Objectives: The aim of this study was to determine the seroprevalence of rubella virus antibodies among women of reproductive age group and assess risk factors of rubella infection. Materials and Methods: A cross-sectional study was carried out among 285 women aged between 15 and 49 years. Enzyme-linked immunosorbent assay (ELISA) method was used to detect and quantify human immunoglobulin G (IgG) antibodies with avidity for rubella virus in sera of participants. Socio-demographic characteristics of the participants, along with recent and previous history of fever and rash among others were obtained using a questionnaire. Statistical analysis was carried out using SPSS version 16. Results: Seroprevalence of rubella IgG among women of reproductive age in Ilorin was 92.3% (95% CI: 89.2%-95.4%). Thus susceptibility rate to rubella infection was 7.7%. Majority (87.1%) of the IgG seropositive participants had high rubella IgG avidity, implying past rubella infection or reinfections. Seroprevalence was significantly higher among participants from lower educational and socio-economic classes compared with other participants (P = .035 and P = .023, respectively). There was a negative correlation between age and rubella specific IgG titer (P = .000). Thus rubella specific IgG titer decreases with increasing age. Conclusion: There is need for vaccination of susceptible women of reproductive age in Ilorin as the rubella susceptibility rate was higher than the 5.0% target set by the World Health Organization (WHO) for prevention of congenital rubella syndrome (CRS).

Whilst the profiling of the transcriptome and proteome even of single-cells becomes feasible, the analysis of the translatome, which refers to all messenger RNAs (mRNAs) engaged with ribosomes for protein synthesis, is still an elaborate procedure requiring millions of cells. Herein, we report the generation and use of “smart materials”, namely molecularly imprinted polymers (MIPs) to facilitate the isolation of ribosomes and translated mRNAs from merely 1,000 cells. In particular, we show that a hydrogel-based ribosome imprinted polymer could recover ribosomes and associated mRNAs from human, simian and mice cellular extracts, but did not selectively enrich yeast ribosomes, thereby demonstrating selectivity. Furthermore, ribosome imprinted polymers enabled the sensitive measurement of an mRNA translational regulatory event, requiring 1,000-fold less cells than current methodologies. These results provide first evidence for the suitability of MIPs to selectively recover ribonucleoprotein complexes such as ribosomes, founding a novel means for sensitive detection of gene regulation.