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Background: Despite the global decline in pediatric HIV infections, infants in sub-Saharan Africa still acquire HIV infection through inappropriate feeding. Objective: The objective of the study was to compare knowledge and predictors of infant feeding behavior between mothers living with HIV and controls of unknown HIV status in Gombe, northeast Nigeria. Methods: A cross-section of clinic-based samples of 84 HIV-positive mothers and 170 controls of unknown status were interviewed using validated questionnaires. Knowledge scores and self-reported infant feeding practices were analyzed. Multivariate logistic regression models were employed to determine predictors for infant feeding practices. Results: Transmission risk perception (95.2% vs. 65.3%) (p0.05). Antenatal attendance, hospital delivery, knowledge, and positive attitude predicted infant feeding practices in both groups. The predictive roles of education and parity were limited to HIVpositive mothers, while the effects of maternal age and infant death were restricted to controls. Conclusion: Risk perception, knowledge, and exclusive breastfeeding rates were higher among mothers living with HIV. Antenatal care, hospital delivery, knowledge, and attitude predicted infant feeding practices in both groups. Girl child education, antenatal care, hospital delivery, and sustained promotion of exclusive breastfeeding with antiretroviral therapy are key to HIV-free infant survival.

BackgroundThe 10-valent pneumococcal conjugate vaccine (PCV10) was introduced in Nigeria without any baseline data on serotype distribution in invasive pneumococcal disease (IPD). To estimate the proportion of IPD attributable to different serotypes, in children aged MethodsWe used the carriage data from one urban and one rural setting in Nigeria, collected within five months of PCV10 introduction (2016). For Model A, we used serotype-specific adult case-fatality ratios from Denmark as proxy for IC. In the second model, we used the ratio of IPD proportions to carriage prevalence (case-carrier ratios) from Kenya (Model B) and the ratio of IPD incidence to carriage acquisition (attack rates) from the UK (Model C) as measures of serotype IC.ResultsThe models predict that serotypes with high carriage prevalence (6A, 6B, 19F and 23F) will dominate IPD. Additionally, Models B and C predictions emphasize serotypes 1, 4, 5, and 14, which were not prevalent in carriage but had high IC estimates. Non-PCV10 serotypes,6A and 19A, also dominated IPD predictions across models and settings. The predicted proportion of IPD attributed to PCV10 serotypes varied between 56% and 74% by model and setting.ConclusionCarriage data can provide preliminary insights into IPD serotypes in settings that lack robust IPD data. The predicted PCV10-serotype coverage for IPD was moderately high. However, predictions for non-PCV10 serotypes indicate that higher-valency PCVs that cover serotypes 6A and 19A may have a larger impact on IPD reductions.

BackgroundPneumococcal Conjugate Vaccines (PCVs) reduce the burden of pneumococcal disease by reducing nasopharyngeal acquisition and transmission of serotypes in the vaccines (vaccine-serotypes). Following introduction of the 10-valent PCV (PCV10) in Nigeria, we assessed the population-level impact of PCV introduction on pneumococcal carriage.MethodsWe conducted annual cross-sectional carriage and vaccination coverage surveys between 2016 and 2020 in rural and urban sites in Nigeria. We recruited a random sample of residents and used WHO-recommended laboratory methods to identify pneumococcal serotypes. We modelled prevalence ratios for the change in annual carriage prevalence using log-binomial regression, and explored the association between vaccination coverage in children FindingsWe enrolled 4,684 and 3,653 participants for the carriage surveys and 2,135 and 1,106 children for the coverage surveys in the rural and urban sites, respectively. Carriage prevalence of vaccine-serotypes declined steadily with increasing levels of PCV10 coverage among children aged ConclusionsWe found significant reduction in vaccine-serotype carriage at a population level following a steady increase in PCV10 coverage, indicating direct and indirect vaccine effects.

Adverse Events Following Immunisation (AEFI) contribute to child morbidity and mortality as they often lead to low uptake of vaccines with consequent persistence of vaccine-preventable diseases. It is essential to assess the prevalence of AEFIs in northern Nigeria, where misconceptions about immunisation exist. This study assessed the prevalence and pattern of AEFI among children less than 24 months after attending immunisation clinics in Kano, Nigeria. Using a mixed-methods design, adapted intervieweradministered questionnaires were assigned to a cross-section of 384 mother-baby pairs who presented to the immunisation clinics of selected primary healthcare centres (PHCs) within metropolitan Kano. This was followed by six sessions of focus group discussion with a sub-sample of the mothers. Logistic regression and the framework approach were used to analyse the data. The prevalence of AEFI was (43.5%, n=164), and most cases (72.4%, n=273) were mild. Fever was the most common type of AEFI reported (66.5%, n=109) and was higher among infants less than three months (44.5%, n=73). Age of the index child was the only significant predictor of AEFI (OR:0.18, 95% CI: 0.10-0.35). Our study shows that AEFI was common among children less than 24 months old in Kano. We recommend sensitisation and health education of caregivers using valuable communication strategies and sufficient training of immunisation service providers on professional ways to deliver these vaccines safely.

Background: In many African settings, infant and child care practices are dictated by long-established social norms and cultural values, some of which may be disastrous to the health of the baby. To determine how maternal education is related with child health and rearing practices in Kano. Materials and Methods: Using a descriptive cross-sectional design, 386 randomly selected mothers of under-five children and their babies were examined. Data were analyzed using IBM SPSS Statistics for Windows, version 22 (IBM Corp., Armonk, NY, USA). Children's weight-for-height, height-for-age, and weight-for-age Z-scores were obtained. Infant and child care, feeding and weaning practices were assessed and scored based on a system adapted from past study. Results: The mean ± standard deviation of the mothers was 27.3 ± 5.2 years, 69.7% had at least secondary school education. The mothers had 4 ± 2 children, and 79.3% were ≥12 months old. More than half of the children (58.2%) had suffered one or more of the common childhood diseases within the previous month, 60.3% had a form of malnutrition and less than half (42.5%) were fully immunized for age. Varying infant and child care, feeding and weaning practices were observed. Overall, half (49.2%) of the mothers had good care practices, 42.2% had good feeding practices and 57.6% had good weaning practices. Interestingly, neither the mothers' care practices nor the feeding practices were statistically associated with their educational status. However, the proportion of the mothers with good weaning practices was higher among those with no secondary education (59.7%). Conclusion: The finding suggests that cultural beliefs are specific areas of focus in campaigns for improving infant and child care and rearing practices of mothers, and eventually for reducing the high infant and child morbidity and mortality in the Northern Nigeria.

Background: Overconsumption of energy drinks (EDs) is a global public health concern because of its potential health consequence. Objectives: This study aimed to determine the prevalence and factors associated with ED consumption amongst undergraduate students in Kano, Northwest Nigeria. Methodology: A descriptive cross-sectional study design was used to study 381 undergraduate students, selected using a two-stage sampling technique. Data were collected using interviewer-administered questionnaires and analysed using SPSS version 22.0 with P ≤ 0.05 considered to be statistically significant. Results: A total of 381 students were studied. The mean ± standard deviation age of the students was 23.1 ± 3.6 years with male-to-female distribution of about 1:1. Period prevalence of 67.0% within the last 30 days and point prevalence of 23.9% were found. The commonly used ED was Power Horse 44.6%. Up to 59.6% consumed EDs to boost their physical and mental capacity. Odds of ever-consuming EDs were lower in female undergraduates (adjusted odds ratio [aOR]: 0.5, 95% confidence interval [CI]: 0.3–0.7) and higher in Hausa/Fulani ethnic group (aOR: 1.7, 95% CI: 1.04–2.7). Amongst those who were currently consuming EDs, being 24 years or less (aOR: 1.9, 95% CI: 1.04–3.4) and coming from the Hausa/Fulani tribe (aOR: 2.5, 95% CI: 1.4–4.4) were associated with increased consumption. Male undergraduates (aOR: 0.2, 95% CI: 0.1–0.4) and students who were residing on campus were less likely to be current consumers of EDs (aOR: 0.5, 95% CI: 0.3–0.9). Conclusion: Consumption of EDs is increasing amongst students and therefore relevant government agencies should ensure regulated advertisement and consumption to avert the health consequences.

In countries with low tuberculosis (TB) incidence, TB is concentrated in vulnerable populations, including people living with the human immunodeficiency virus (PLHIV), who have a substantially greater risk of TB than people without HIV. We searched PubMed, EMBASE and Web of Science for studies evaluating the risk factors for latent tuberculous infection (LTBI) or active TB in PLHIV in countries with TB incidence 10 per 100 000 population. Due to the number of risk factors evaluated and heterogeneity in study designs, we present summary data and a narrative synthesis. We included 45 studies: 17 reported data on the risk factors for LTBI and 32 on active TB. Black, Asian or Hispanic ethnicity, birth or long-term residence in a country with high TB incidence, and HIV acquisition via injecting drug use (IDU) or heterosexual sex were strong predictors of both LTBI and active TB. History of contact, a greater degree of immunosuppression at diagnosis or higher viral load increased the TB risk. Early HIV diagnosis to allow timely initiation of antiretroviral therapy is essential for the prevention of TB in PLHIV. Screening and treating PLHIV for LTBI to reduce the risk of progression to active TB disease should also be considered to further reduce the burden of active TB in low TB incidence settings. Research to support the expansion of TB and HIV prevention and treatment globally is essential to eliminate TB in low-incidence settings.

Several innovations that can improve immunization systems already exist. Some interventions target service consumers within communities to raise awareness, build trust, improve understanding, remind caregivers, reward service users, and improve communication. Other interventions target health facilities to improve access and quality of vaccination services among others. Despite available empirical evidence, there is a delay in translating innovations into routine practice by immunization programmes. Drawing on an existing implementation science framework, we propose an interactive, and multi-perspective model to improve uptake and utilization of available immunization-related innovations in the African region. It is important to stress that our framework is by no means prescriptive. The key intention is to advocate for the entire immunization system to be viewed as an interconnected system of stakeholders, so as to foster better interaction, and proactive transfer of evidence-based innovation into policy and practice.

Changes in nasopharyngeal (NP) carriage of vaccine-type (VT) Streptococcus pneumoniae can be used to assess the effectiveness of a pneumococcal conjugate vaccine (PCV10). We conducted a baseline carriage survey in rural (Kumbotso, Kano) and urban (Pakoto, Ogun) Nigeria. In this cross-sectional study, we obtained data on demography, clinical history, risk factors, and took NP swabs for pneumococcal culture. We calculated crude and age-standardised carriage prevalence and used log-binomial regression to assess risk factors for carriage. Among children aged 40% across all ages. The age-standardized prevalence of pneumococcal carriage was 66% in Kumbotso and 40% in Pakoto. The most commonly identified serotypes were 19 F, 6 A and 23 F. Risk factors for carriage were young age, recent rhinorrhoea, cohabitation with ≥2 children aged

Background Successful tuberculosis (TB) treatment is essential to effective TB control. TB-HIV coinfection, social determinants and access to services influenced by rural residence can affect treatment outcome. We examined the separate and joint effects of rural residence and HIV infection on poor treatment outcome among patients enrolled in a large TB treatment centre in Kano, Nigeria. Methods We retrospectively analysed a cohort of patients with TB enrolled in a large urban TB clinic in northern Nigeria, from January 2010 to December 2014. Poor treatment outcome was defined as death, default or treatment failure. We used Poisson regression to model rates and determine the relative risks (and 95% confidence intervals, CI) of poor treatment outcomes. Results Among 1381 patients included in the analysis, 28.4% were rural residents; 39.8% were HIV-positive; and 46.1% had a poor treatment outcome. Approximately 65 and 38% of rural and urban residents, respectively, had a poor treatment outcome. Rural residents had 2.74 times (95% CI: 2.27–3.29) the risk of having a poor treatment outcome compared to urban residents. HIV-positive patients had 1.4 times (95% CI: 1.16–1.69) the risk of poor treatment outcome compared to HIV-negative patients. The proportion of poor treatment outcome attributable to rural residence (population attributable fraction, PAF) was 25.6%. The PAF for HIV infection was 11.9%. The effect of rural residence on poor treatment outcome among HIV-negative patients (aRR:4.07; 95%CI:3.15–5.25) was more than twice that among HIV-positive patients (aRR:1.99; 95%CI:1.49–2.64). Conclusion Rural residents attending a large Nigerian TB clinic are at increased risk of having poor treatment outcomes, and this risk is amplified among those that are HIV-negative. Our findings indicate that rural coverage of HIV services may be better than TB services. These findings highlight the importance of expanding coverage of TB services to ensure prompt diagnosis and commencement of treatment, especially among rural-dwellers in resource-limited settings.

BACKGROUND: Despite availability of effective cure, tuberculosis (TB) remains a leading cause of death in children. In many high-burden countries, childhood TB is underdiagnosed and underreported, and care is often accessed too late, resulting in adverse treatment outcomes. In this study, we examined the time to death and its associated factors among a cohort of children that commenced TB treatment in a large treatment centre in northern Nigeria. METHODS: This is a retrospective cohort study of children that started TB treatment between 2010 and 2014. We determined mortality rates per 100 person-months of treatment, as well as across treatment and calendar periods. We used Cox proportional hazards regression to determine adjusted hazard ratios (aHR) for factors associated with mortality. RESULTS: Among 299 children with a median age 4 years and HIV prevalence of 33.4%; 85 (28.4%) died after 1,383 months of follow-up. Overall mortality rate was 6.1 per 100 person-months. Deaths occurred early during treatment and declined from 42.4 per 100 person-months in the 1st week of treatment to 2.2 per 100 person-months after at the 3rd month of treatment. Mortality was highest between October to December period (9.1 per 100 pm) and lowest between July and September (2.8 per 100 pm). Risk factors for mortality included previous TB treatment (aHR 2.04:95%CI;1.09-3.84); HIV infection (aHR 1.66:95%CI;1.02-2.71), having either extra-pulmonary disease (aHR 2.21:95%CI;1.26-3.89) or both pulmonary and extrapulmonary disease (aHR 3.03:95%CI;1.70-5.40). CONCLUSIONS: Mortality was high and occurred early during treatment in this cohort, likely indicative of poor access to prompt TB diagnosis and treatment. A redoubling of efforts at improving universal health coverage are required to achieve the End TB Strategy target of zero deaths from TB.

Background Multidrug resistant tuberculosis (MDR-TB), is an emerging public health problem in sub-Saharan Africa (SSA). This study aims to determine the trends in prevalence of MDR-TB among new TB cases in sub-Saharan Africa over two decades. Methods We searched electronic data bases and accessed all prevalence studies of MDR-TB within SSA between 2007 and 2017. We determined pooled prevalence estimates using random effects models and determined trends using meta-regression. Results Results: We identified 915 studies satisfying inclusion criteria. Cumulatively, studies reported on MDR-TB culture of 34,652 persons. The pooled prevalence of MDR-TB in new cases was 2.1% (95% CI; 1.7-2.5%). There was a non-significant decline in prevalence by 0.12% per year. Conclusion We found a low prevalence estimate of MDR-TB, and a slight temporal decline over the study period. There is a need for continuous MDR-TB surveillance among patients with TB.

Background The global burden of anemia is large especially in sub-Saharan Africa, where HIV is common and lifestyles are changing rapidly with urbanization. The effects of these changes are unknown. Studies of anemia usually focus on pregnant women or children, among whom the burden is greatest. We describe prevalence and risk factors for anemia among rural and urban men and women of all ages in Malawi. Methods We analyzed data from a population-wide cross-sectional survey of adults conducted in two sites, Karonga (rural) and Lilongwe (urban), commencing in May 2013. We used multinomial logistic regression models, stratified by sex to identify risk factors for mild and moderate-to-severe anemia. Results Anemia prevalence was assessed among 8,926 men (age range 18–100 years) and 14,978 women (age range: 18–103 years). Weighted prevalence levels for all, mild, and moderate-to-severe anemia were 8.2, 6.7 and 1.2% in rural men; 19.4, 12.0 and 7.4% in rural women; 5.9, 5.1 and 0.8% in urban men; and 23.4, 13.6 and 10.1% in urban women. Among women, the odds of anemia were higher among urban residents and those with higher socioeconomic status. Increasing age was associated with higher anemia prevalence in men. Among both men and women, HIV infection was a consistent risk factor for severity of anemia, though its relative effect was stronger on moderate-to-severe anemia. Conclusions The drivers of anemia in this population are complex, include both socioeconomic and biological factors and are affecting men and women differently. The associations with urban lifestyle and HIV indicate opportunities for targeted intervention.