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Introduction: Sufficient laboratory capacity is vital to containing infectious diseases outbreaks. This study was conducted to assess SARS-CoV-2 testing performance, the strategies adopted to scale up laboratory testing capacity, and to highlight challenges and lessons learnt in Nigeria’s response to COVID-19 pandemic regarding testing strategies.Methods This cross-sectional descriptive study adopted a mixed method approach including desk reviews and key informant interviews (KIIs). The KIIs were conducted among actors of the COVID-19 response teams in states (SMoH) and the Federal Ministry of Health (FMoH) in Nigeria. Data extraction tools were populated from the relevant online resources and documents of the FMoH, SMoH and the Nigeria Centre for Disease Control.Results At the beginning of the pandemic in Nigeria, testing performance was poor, but this improved over time. To manage the demand for testing, Nigeria adopted targeted testing with a focus on symptomatic contacts and alerts, returning travelers from high-risk countries who were symptomatic during the quarantine period, among others groups. Strategies to enhance laboratory capacity and improve the turnaround time for results included leveraging on existing tuberculosis laboratory network or building new laboratories where none existed; decentralization of sample collection and testing; staff health workers repurposing and hiring of volunteers; training and retraining of laboratory personnel; adoption of rapid diagnostic testing; and strengthening public-private partnerships to leverage the private sector testing. From an initial three laboratories with capacity to test for SARS-CoV-2 in February, 2020, the number of laboratories increased to 158 by March, 2022. Although laboratory capacity increased, logistics and supply chain disruption was still a challenge.Conclusion Investment in local manufacturing capacities of laboratory consumables such as RDTs and reagents would promote self-reliance and sustainability for a country as populous as Nigeria.

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.

Background This study was carried out to enable an assessment of geospatial distribution and access to healthcare facilities under the National Health Insurance Scheme (NHIS) of Nigeria. The findings will be useful for efficient planning and equitable distribution of healthcare resources. Methods Data, including the distribution of selected health facilities, were collected in Ibadan, Nigeria. The location of all facilities was recorded using Global Positioning System and was subsequently mapped using ArcGIS software to produce spider-web diagrams displaying the spatial distribution of all health facilities. Results The result of clustering analysis of health facilities shows that there is a statistically significant hotspot of health facility at 99% confidence located around the urban areas of Ibadan. The significant hotspot result is dominated by a feature with a high value and is surrounded by other features also with high values. Away from the urban built-up area of Ibadan, health facility clustering is not statistically significant. There was also a high level (94%) of bypassing of NHIS-accredited facilities among the enrollees. Conclusions Lopsided distribution of health facilities in the study area should be corrected as this may result in inequity of access to available health services.

Background Female genital cutting (FGC) inflicts life-long injuries on women and their female children. It constitutes a violation of women’s fundamental human rights and threats to bodily integrity. Though decreasing, the practice is high and widespread in Nigeria despite efforts towards its eradication. This study was conducted to perform cohort analysis of the state of FGC between the years 2009 and 2018 in Nigeria. Results The study found that that FGC has reduced over the years from 56.3% among the 1959–1963 birth cohort to 25.5% among 1994–1998 cohorts but a rise in FGC between 1994–1998 cohorts and 1999–2003 cohorts (28.4%). The percentage of respondents who circumcised their daughters reduced from 40.1% among the oldest birth cohort to 3.6% among the younger cohort. Birth-cohort, religion, education, residence, region, and ethnicity were associated with FGC. Factors associated with the daughter’s circumcision were birth-cohort, religion, residence, region, ethnicity, wealth, marital status, FGC status of the respondent, and FGC required by religion. Similar factors were found for discontinuation intention. Conclusions The practice of FGC is still high but decreasing among younger birth-cohorts in Nigeria. There is no significant change in the perception of the discontinuation of FGC. More awareness about the adverse effects of FGC, particularly among women with poor education in Nigeria will greatly reduce this cultural menace’s timely eradication.

BACKGROUND Globally, child mortality and morbidity remain a serious health challenge and infectious diseases are the leading causes. The use of count models together with spatial analysis of the number of vaccines taken is limited in the literature. We used Spatio-temporal in a Bayesian zero-inflated Poisson regression model to assess the number of vaccine uptake among children aged 12–23 months and their associated factors. METHODS Data of 19,564 children from 2003, 2008, 2013 and 2018 population-based cross-sectional Nigeria Demographic and Health Survey were used. The childhood vaccines include one dose of Bacillus-Calmette-Guérin; three doses of Diphtheria-Pertussis-Tetanus; three doses of Polio and one dose of Measles. Uptake of all nine vaccines was regarded as full vaccination. We examined the multilevel factors associated with the number of vaccine uptake using descriptive, bivariable and multivariable Bayesian models. Analysis was conducted in Stata version 16 and R statistical packages, and visualization in ArcGIS. RESULTS Prevalence of full vaccination was 6.5% in 2003, 14.8% in 2008, 21.8% in 2013 and 23.3% in 2018. Full vaccination coverage ranged from 1.7% in Sokoto to 51.9% in Anambra. Factors associated with the number of vaccines include maternal age (adjusted Incidence “risk” Ratio (aIRR) = 1.05; 95% Credible Interval (CrI) = 1.03–1.07) for 25–34 years and (aIRR = 1.07; 95% CrI = 1.05–1.10) for 35–49 years and education: (aIRR = 1.11, 95% CrI = 1.09–1.14) for primary and (aIRR = 1.16; 95% CrI = 1.13–1.19) for secondary/tertiary education. Other significant factors are wealth status, antenatal care attendance, working status, use of skilled birth attendant, religion, mother’s desire for the child, community poverty rate, community illiteracy, and community unemployment. CONCLUSION Although full vaccination has remained low, there have been improvements over the years with wide disparities across the states. Improving uptake of vaccines by educating women on the benefits of hospital delivery and vaccines through radio jingles and posters should be embraced, and state-specific efforts should be made to address inequality in access to routine vaccination in Nigeria.

Background:Malaria is associated with high morbidity and mortality especially in World’s tropical regions. In 2016, an estimated 216 million and 445,000 cases of malaria and deaths associated with malaria respectively were reported globally. Malaria is the first leading cause of outpatient visits, hospitalization and death in Burundi. We therefore examined the trend in malaria cases and deaths in Burundi.Methods:We extracted data from Burundi National Health Information System (BNHIS) and assessed trends in malaria cases and deaths from January 2015 to December 2017. A suspected case of malaria was defined as any person treated by anti-malarial drugs without testing while a confirmed case as any person with a positive microscopy or rapid diagnostic test for malaria parasite. We described malaria cases and deaths, and calculated malaria case incidence rate.Results:A total of22,225,699 malaria cases with 8,660 deaths (CFR 0.04%) was documented during the study period. Out of 22,225,699 cases, 45,291 cases (0.2%) were suspected malaria cases. The observed peak season of malaria infection in any of the studied year was in the raining season (March-June). All provinces of the country were affected. Kirundo and Cankuzo provinces the incidence of malaria cases increased from 10.1 cases per 1,000 persons in 2015 to 13.2 cases per 1,000 persons in 2017. The case fatality rate decreased from 0.06% in 2015 to 0.01% in 2017.Conclusions:An increasing trend in malaria prevalence was observed in Burundi but Kirundo and Cankuzo provinces were the most affected. However, the case fatality decreased within the studied period. Malaria intervention should be intensified/scaled up in the raining season and the most affected provinces.

Background: Malaria in pregnancy accounts for 11% of maternal death in Nigeria. Plateau State has a low uptake of intermittent preventive treatment of malaria among women attending antenatal care. Objectives: This study examined the trend and made projections of reported cases of malaria in pregnancy in Plateau State. Methods: Data were extracted from the state disease surveillance system from January 2013 to December 2017. Reported cases of malaria in pregnancy within the 5 years under investigation were retrieved, merged and sorted by month of reporting and Local Government Area (LGA). Prevalence was calculated yearly for each LGA in Plateau State using Geographic Information System. Seasonal variation and projection were based on a multiplicative time series model. Results: In total, 62,997 cases of malaria in pregnancy were retrieved. Prevalence was 6.9% in 2013 and increased to 15.1% in 2017. Higher prevalence was observed in Wase, Kanam and Shendam LGAs. A cyclical trend with highest number of malaria in pregnancy cases was found within the third quarter of all the years. Within the 5 years, there was higher seasonal variation for quarters three (1.209834) and one (1.099711). The highest number of cases of malaria in pregnancy was likely to occur in the third quarter, while the least was found in the second quarter. The projected numbers of malaria in pregnancy cases are 20,121, 22,593 and 25,064 for year 2018, 2019 and 2020, respectively, and the highest number of cases occurs in the third quarter. Conclusion: Malaria in pregnancy follows an increasing trend in Plateau State, with greatest severity in the third quarter of the year. An effective intervention strategy against malaria among pregnant women is advocated.

Background Rivers State is among the states with high HIV prevalence in Nigeria. Occupational exposure to HIV through blood or body fluids of HIV/AIDS patients is a recognised risk factor of HIV infections among healthcare workers. We identified the determinants of occupational exposures to HIV among healthcare workers in Prevention of Maternal to Child Transmission (PMTCT) sites within Port Harcourt metropolis in Rivers State. Methods A descriptive cross-sectional study was conducted and multi-stage sampling technique was used to select 341 healthcare providers from 22 public and 22 private health facilities in PMTCT sites in Port Harcourt metropolis. The data collected were analysed using descriptive statistics, Chi-square and logistic regression models (p-value = 0.05). Results Respondents’ mean age was 35.9 ± SD8.4 years, 270 (80.1%) and 171(50.7%) were females, and from public health facilities respectively. Prevalence of occupational exposure of healthcare workers to HIV in the past 12 months was 153 (45.0%), and 96 (63.3%) experienced such exposure more than once. Contacts with potentially infectious body fluid accounted for the largest proportion 51 (33.3%); followed by needle stick prick 49 (32.6%). About 189 (56.1%) had safety information at their disposal and this serves as a reminder on safety precautions. The likelihood of occupational exposure was significantly higher among doctors (AOR = 2.22, 95% C.I = 1.16–4.25,) but lower among environmental health workers (AOR = 0.10, 95% C.I = 0.02–0.46,) than nurses/midwives when other factors were included in the model. Conclusion Occupational exposure to blood and body fluids remains a frequent occurrence among healthcare workers; highest among doctors in PMTCT sites in the study area. Provision of protective safety materials, training and enforcement of adherence to universal precaution strategies are highly recommended.

Perceived quality of care is a determinant of uptake of health services. This study aimed to assess the determinants of quality of care of enrollees in the National Health Insurance Scheme (NHIS) in Nigeria. The outcome was satisfaction with health care services, which was used as a proxy for quality. Findings will assist in the intervention to enhance enrollment in the scheme and for universal health coverage attainment. This was a descriptive cross-sectional study conducted among enrollees in selected NHIS facilities in Ibadan, Nigeria. Data on satisfaction with health care were collected among selected 432 enrollees with the aid of an adapted semi-structured WHO-USAID interviewer-administered questionnaire. Data were analyzed using chi-square and multiple logistic regression models (α = 0.05). Among predictors of satisfaction with health services were younger age (OR = 1.85, 95% CI = 1.05–3.25, p = .024), working in the private sector (OR = 1.84, 95% CI = 1.03–3.28, p = .022), and seeking information about quality of services prior enrollment (OR = 1.63, 95% CI = 1.04−2.53, p = .013). Targeted intervention based on the findings of this study should be implemented to improve satisfaction with the services offered.

Background The coronavirus disease (COVID-19) remains a global public health issue due to its high transmission and case fatality rate. There is apprehension on how to curb the spread and mitigate the socio-economic impacts of the pandemic, but timely and reliable daily confirmed cases' estimates are pertinent to the pandemic's containment. This study therefore conducted a situation assessment and applied simple predictive models to explore COVID-19 progression in Nigeria as at 31 May 2020. Methods Data used for this study were extracted from the websites of the European Centre for Disease Control (World Bank data) and Nigeria Centre for Disease Control. Besides descriptive statistics, four predictive models were fitted to investigate the pandemic natural dynamics. Results The case fatality rate of COVID-19 was 2.8%. A higher number of confirmed cases of COVID-19 was reported daily after the relaxation of lockdown than before and during lockdown. Of the 36 states in Nigeria, including the Federal Capital Territory, 35 have been affected with COVID-19. Most active cases were in Lagos (n = 4064; 59.2%), followed by Kano (n = 669; 9.2%). The percentage of COVID-19 recovery in Nigeria (29.5%) was lower compared to South Africa (50.3%), but higher compared to Kenya (24.1%). The cubic polynomial model had the best fit. The projected value for COVID-19 cumulative cases for 30 June 2020 in Nigeria was 27,993 (95% C.I: 27,001–28,986). Conclusion The daily confirmed cases of COVID-19 are increasing in Nigeria. Increasing testing capacity for the disease may further reveal more confirmed cases. As observed in this study, the cubic polynomial model currently offers a better prediction of the future COVID-19 cases in Nigeria.

Objectives This study assessed the timing of the first ANC visit among pregnant women and identified its prognostic factors. Design Data obtained from 2013 Nigerian DHS, a cross-sectional and nationally representative survey, were used. Methods We included women who had had at least a childbirth or got a pregnancy terminated within the five years preceding the survey or currently pregnant as of the time of the survey. The outcome variable is the timing of the first ANC visit to skilled ANC service provider. Those who were either currently pregnant or lost pregnancy but have not accessed ANC were censored. Basic descriptive statistics and survival analysis techniques involving four models were used to analyze the data at p = 0.05. Data was weighted and adjustment made for survey design and sampling errors. Results Almost half of the respondents were aged 25–34 years. Only 65.5% had at least one contact with skilled ANC providers and such visits were initiated mostly (58%) in the second trimester. The overall incidence rate of accessing ANC per month is 110 per 1000 women. Women with higher education had a higher adjusted hazard of accessing ANC than uneducated women (aHR = 2.89, 95% CI: 2.68–3.11). Older women from households in richer wealth quintile are more likely to initiate ANC. Women from households in richer wealth quintiles, those who had no problem in accessing ANC facilities, those with higher education, residing in urban areas and in the Southern region had a higher tendency of earlier ANC initiation. Conclusion ANC utilization in Nigeria is low and the timings of first visits are delayed. For Nigeria to achieve timely and adequate use of ANC services, health facilities should be more accessible and women should be empowered in terms of education, autonomy, and earnings in addition to changes in social-cultural practices that prevent ANC uptakes.

Background Diarrhoea poses serious health problems among under-five children (U5C) in Low-and Medium-Income Countries (LMIC) with a higher prevalence in rural areas. A gap exists in knowledge on factors driving rural-non-rural inequalities in diarrhoea development among U5C in LMIC. This study investigates the magnitude of rural-non-rural inequalities in diarrhoea and the roles of individual-level and neighbourhood-level factors in explaining these inequalities. Methods Data of 796,150 U5C, from 63,378 neighbourhoods across 57 LMIC from the most recent Demographic and Health Survey (2010–2018) was analysed. The outcome variable was the recent experience of diarrhoea while independent variables consist of the individual- and neighbourhood-level factors. Data were analysed using multivariable Fairlie decomposition at p Results Two-thirds (68.0%) of the children are from rural areas. The overall prevalence of diarrhoea was 14.2, 14.6% vs 13.4% among rural and non-rural children respectively (p p = 0.001), Benin (OR = 1.209; p = 0.002), Burundi (OR = 1.399; p p p p = 0.029), Egypt (OR = 1.331; p p = 0.027), India (OR = 1.059; p p p = 0.017), Mali (OR = 1.240; p = 0.001), Myanmar (OR = 1.422; p = 0.004), Namibia (OR = 1.451; p p p = 0.010), South Africa (OR = 1.420; p = 0.002), Togo (OR = 1.729; p Conclusions The gaps in the odds of diarrhoea among rural children than nonrural children were explained by individual-level and neighbourhood-level factors. Sustainable intervention measures that are tailored to country-specific needs could offer a better approach to closing rural-non-rural gaps in having diarrhoea among U5C in LMIC.

BackgroundLow-and Medium-Income Countries (LMIC) continue to record a high burden of under-five deaths (U5D). There is a gap in knowledge of the factors contributing to housing materials inequalities in U5D. This study examined the contributions of the individual- and neighbourhood-level factors to housing materials inequalities in influencing U5D in LMIC.MethodsWe pooled data from the most recent Demographic and Health Surveys for 56 LMIC conducted between 2010 and 2018. In all, we analysed the data of 798,796 children living in 59,791 neighbourhoods. The outcome variable was U5D among live births within 0 to 59 months of birth. The main determinate variable was housing material types, categorised as unimproved housing materials (UHM) and improved housing materials (IHM) while the individual-level and neighbourhood-level factors are the independent variables. Data were analysed using the Fairlie decomposition analysis at α = 0.05.ResultsThe overall U5D rate was 53 per 1000 children, 61 among children from houses built with UHM, and 41 among children from houses built with IHM (p ConclusionsThere are variations in individual- and neighbourhood-level factors driving housing materials inequalities as it influences U5D in LMIC. Interventions focusing on reducing the burden of U5D in households built with UHM are urgently needed.

Background COVID-19 is an emerging public health emergency of international concern. The trajectory of the global spread is worrisome, particularly in heavily populated countries such as Nigeria. The study objective was to assess and compare the pattern of COVID-19 spread in Nigeria and seven other countries during the first 120 days of the outbreak. Methods Data was extracted from the World Bank’s website. A descriptive analysis was conducted as well as modelling of COVID-19 spread from day one through day 120 in Nigeria and seven other countries. Model fitting was conducted using linear, quadratic, cubic and exponential regression methods (α=0.05). Results The COVID-19 spread pattern in Nigeria was similar to the patterns in Egypt, Ghana and Cameroun. The daily death distribution in Nigeria was similar to those of six out of the seven countries considered. There was an increasing trend in the daily COVID-19 confirmed cases in Nigeria. During the lockdown, the growth rate in Nigeria was 5.85 (R2=0.728, p2=0.625, pp Conclusions Improvement in COVID-19 control measures and strict compliance with the COVID-19 recommended protocols are essential. A contingency plan is needed to provide care for the active cases in case the predicted target is attained.

BackgroundThere is disparity in fertility level across the six geopolitical zones in Nigeria. Deeper uunderstanding about the drivers of fertility trends are necessary to prioritize zonal specific strategies for fertility reduction in Nigeria. Thus, this study examined the proximate determinants (PDs) of fertility and decomposed the change in its level across the six geo-political zones in Nigeria.MethodData from Nigeria Demographic and Health Surveys of 2003 and 2018 were analyzed. Fertility data were based on the report of full birth history from women of reproductive age. The Revised Bongaarts framework was used to estimate PDs and fertility levels. The contribution of each PDs to the observed changes in fertility levels was quantified using Das Gupta’s five- factor decomposition method.ResultAcross the zones, there was a change in the fertility inhibiting effect of Contraception (Cc) between 2003 and 2018. The fertility inhibiting effect of Postpartum Infecundability (Ci) and Abortion was the highest and smallest respectively across the zones. The Total fertility rate (TFR) in 2003 and 2008 across the zones are South-South (5.04 vs 4.36), South-West (4.88 vs 4.26), North West (7.25 vs 6.85), North East (6.87 vs 6.54), North Central (5.72 vs 5.48), South East (5.06 vs 4.86), Nigeria (6.00 vs 5.59). Delayed sexual exposure (Cm) and contraceptive use (Cc) contributed the most to the change across the regions. The percentage contribution of Cm in South-South, South West, and South East was 87.04%, 52.89%, and 172.85% respectively. Furthermore, most of the fertility change observed in North Central was attributable to Cc.ConclusionAbortion index was not an important inhibiting factor of fertility in Nigeria. Delayed sexual exposure and contraceptive use accounted for the largest change observed in fertility levels across the six geo-political zones in Nigeria between 2003 and 2018. Strategies that promote delayed sexual exposure, contraceptive use and breast feeding practices will enhance fertility transition in Nigeria.

Maternal undernutrition remains a leading cause of morbidity and mortality in Nigeria. Yet, most interventional programmes are focused on infant and child nutrition outcomes and not on maternal nutrition‐related outcomes. Evidence suggests that the integration of household environmental interventions into nutrition actions can make a difference in reducing the burden of maternal undernutrition. This study examined the influence of household environmental conditions (HHEC) on the nutritional status of women of childbearing age in Nigeria using secondary data from the 2013 Nigeria Demographic and Health Survey. The original sample of 38,948 women age 15–49 years was selected using multi-stage probability sampling. The sample for the current analysis was 23,344 after exclusion of women due to health status or provision of incomplete information. The dependent and main independent variables were undernutrition (defined as Body Mass Index below 18.5) and HHEC (generated from cooking fuel, toilet type, source of drinking water, and housing materials) respectively. Data were analysed using descriptive statistics, Chi-square, and logistic regression model at 5% level of significance. The prevalence of undernutrition among women living in houses with unimproved and improved HHEC was 17.2% and 7.2% respectively. The adjusted odds of undernutrition was significantly higher among women who lived in houses with unimproved HHEC (aOR = 2.02, C.I = 1.37–2.97, p

Background: HIV/AIDS has contributed to increasing orphans and vulnerable children in Nigeria. A measure of vulner- ability is household hunger. Objective: To assess level of household hunger and associated factors among OVC households in Lagos State. Methods: A cross-sectional survey of 1300 OVC households in 5 selected Local Government Areas. The LGAs were select- ed using the Household Vulnerability Assessment index. Data collection was by personal interview of households’ heads/ caregivers using a structured questionnaire capturing socio-demographic, household economic profile and food-related variables. A multivariate logit model was fitted to identify independent predictors of household hunger after adjusting for confounding variables. Results: The population density was 5.1 and 52.8% were females. A larger proportion of females (84.6%) than males (78.3%) reported that they had no food to eat in the last four weeks prior the survey. Poor household economic status (OR=1.41, CI: 1.03-1.92), age and marital status of caregiver were independent predictors of household hunger. The odds of hunger increased with caregiver’s age; higher in households headed by never married (OR=3.99, CI: 1.15-13.89) and di- vorced/separated caregivers (OR=2.39, CI: 1.11-5.12). Conclusion: OVC households experienced severe hunger. Household economic strengthening would be useful strategy to mitigate the nutrition challenges of OVC in Lagos state. Keywords: Orphans; vulnerable; children; households food security; caregivers; economy; Nigeria.

BackgroundMalaria transmission affects malaria infection rates. There are several potential drivers of malaria transmission. A suitable meteorological factor such as rainfall, temperature, and relative humidity encourages the breeding of the vector. This improves the survival of the parasite in the host. The female Plasmodium falciparum plays a crucial role in the variability of malaria prevalence. Lagos State is a coastal malaria-endemic area in Nigeria. This study presents a correlation analysis of malaria cases and meteorological factors between the periods of January 2015 to April 2018 in Lagos state.MethodsThe study was a secondary data analysis of meteorological variables and records of malaria cases reported by health facilities in Lagos state. We accessed weather variables through free access “weather underground.com” a meteorological data sharing service system (MDSSS). The MDSSS provides real-time online weather information from four meteorological monitoring stations in Lagos state. We accessed the malaria cases through the district health information system 2 databases. It is used to report cases of malaria by all the private and public health facilities in the state. We performed the correlation analyses to show the relationship between temperature, humidity, rainfall, and malaria cases at a 5% level of significance. We analysed data using the statistical package for social sciences version 25.ResultsMalaria cases peaked between the period of July to November 2016 and the period of April to May 2017 and declined between March to May 2017. The temperature, relative humidity, and rainfall showed a positive correlation with malaria cases. The temperature is most correlated with the occurrence of malaria cases (r = 0.65, p< 0.02).ConclusionThis correlation analysis provides an approach for studying the impact of meteorological variability on the prevalence of malaria cases. This can help to forecast the malaria epidemic while preparing for the elimination of malaria in Lagos state.

Background: COVID-19 is an emerging global public health crisis. The increase in the daily COVID-19 confirmed cases in Nigeria is worrisome vis-a-vis its large and dense population. This study aims at assessing the pattern of spread in the first 120 days of COVID-19 case confirmation in Nigeria, and its comparison with seven other countries. Methods: Data extracted from the World Bank’s website were used for the descriptive assessment and modelling of COVID-19 disease using the first 120 days of the index case in Nigeria and seven other countries. Linear, quadratic, cubic and exponential methods of regression model were used to fit the data (α=0.05). Results: The COVID-19 growth pattern in Nigeria was similar to that of Egypt, Ghana and Cameroun; Nigeria COVID-19's daily death distribution was comparable to six of the other seven countries considered. There was an increasing trend in the daily COVID-19 confirmed cases in Nigeria. During the lockdown, the growth rate of COVID-19 in Nigeria was 5.85 (R2=0.728, p2=0.625, pConclusions: An improvement in COVID-19 control measures and strict compliance with the COVID-19 recommended protocols are essential. A contingency plan is needed to provide care for the active cases in case the predicted target is realised.

Background Globally, infant mortality has declined considerably but has remained unacceptably high in sub-Saharan Africa, especially Nigeria where infant mortality rate is 67/1000 live births. To facilitate infant mortality reduction in Nigeria, an understanding of the synergistic effect of bio-demographic characteristics of mothers known as High Risk Birth Behaviours (HrBBs) is important. We therefore investigated the influence of HrBBs on infant survival in Nigeria. Methods This cross-sectional study design utilized data from the 2018 round of Nigerian Demographic Health Survey. The study participants were a representative sample of women of reproductive age (n = 21,350) who had given birth within the 5 years preceding the survey. HrBBs was measured through integration of information on maternal age at child’s birth, parity, and preceding birth interval with respect to the most recent child. The HrBBs was categorized as none, single and multiple. Data were analysed using descriptive statistics, Log-rank test and Cox proportional hazard model (α =0.05). Results The mean age of the women was 29.7 ± 7.2 and 4.1% had experienced infant death. Infant mortality was highest among women with multiple HrBBs (5.1%). Being a male, having small size at birth, failure to receive tetanus injection, non-use of contraceptives and living in the core-north (North West and North East) predisposed children to higher risk of dying before 12 months of age. The hazard ratio of infant mortality was significantly higher among infants of mothers in multiple HrBBs category (aHR = 1.66; CI: 1.33–2.06) compared to their counterparts with no HrBBs. Conclusion Multiple HrBBs increase the chances of dying among infants in Nigeria. Screening women for HrBBs for special health attention during pregnancy, birth and postnatal period will alleviate infant death in Nigeria.

Introduction:in Nigeria, perinatal mortality rate remains high among births at the health facility. Births occur majorly at the secondary healthcare level in Abuja Municipal Area Council (AMAC) of the Federal Capital Territory (FCT). Identifying factors influencing perinatal deaths in this setting would inform interventions on perinatal deaths reduction. We assessed perinatal mortality and its determinants in public secondary health facilities in AMAC. Methods:delivery and neonatal data from two selected public secondary health facilities between 2013 and 2016 were reviewed and we extracted maternal socio-demographics, obstetrics and neonatal data from hospital delivery, newborns´ admissions and discharge registers. Data were analyzed using descriptive statistics and Cox proportional hazard models (α = 5%). Results:perinatal mortality rate was 129.5 per 1000 births. Asphyxia 475 (34.0%), neonatal infection 279 (20.0%) and prematurity 242 (17.3%) accounted for majority of the 1,398 perinatal deaths. Unbooked status [aHR = 1.8 (95% CI 1.4 - 2.2)], antepartum haemorrhage [aHR = 2.8 (95% CI 1.2 - 6.7)], previous perinatal death [aHR = 2.3 (95% CI 1.7 - 3.1)] and maternal age ≥ 35 years [aHR= 1.4 (95% CI 1.0 - 1.8)] were associated with increased risk of perinatal death. Conclusion:perinatal mortality in the studied hospitals was high. Determinants of perinatal death were unbooked antenatal care (ANC) status, antepartum haemorrhage, previous perinatal death and high maternal age. Reducing perinatal deaths would require improving antenatal care attendance with healthcare staff identifying and targeting women at risk of pregnancy complications.

Nigeria is one of the high fertility countries worldwide. Little is known about the differences in fertility experience of women in poor and rich households in Nigeria. We examined the relationship between household wealth and fertility in Nigeria with focus on women from poor and rich households.This national representative and cross-sectional design study involved analysis of four rounds (2003, 2008, 2013, 2018) of Nigeria Demographic Health and Survey data . The outcome variable was fertility measured from the full birth history information reported by women of reproductive age. Data were analyzed using descriptive statistics, direct and Gompertz-relational demographic methods, logistic regression and negative binomial regression models (α=0.05).Across the survey years, the mean number of children ever born (CEB), the total fertility rate and the percentage of women who had high fertility were consistently higher among the women from poor households than those from the rich households. From 2003 to 2018, declining pattern (slope = -0.87) in percentage of high fertility women was observed among rich unlike the poor women (slope = +0.31) where a slight increase was observed. In 2018 as for other survey rounds, about 18.7% and 38.4% of rich and poor women had high fertility (CEB≥5) respectively. The likelihood of high fertility (CEB≥5) was 2.74 (C.I=2.60-2.89, p

Background: COVID-19 is an emerging global public health crisis. The increase in the daily COVID-19 confirmed cases in Nigeria is worrisome vis-a-vis its large and dense population. This study aims at assessing the first 120 days of COVID-19 case confirmation in Nigeria.Methods: Data extracted from the World Bank’s website were used for the descriptive assessment and modelling of COVID-19 disease using the first 120 days of the index case in Nigeria and seven other countries. Linear, quadratic, cubic and exponential methods of regression model were used to fit the data (α=0.05).Results: The COVID-19 growth pattern in Nigeria was similar to that of Egypt, Ghana and Cameroun; Nigeria COVID-19's daily death distribution was comparable to six of the other seven countries considered. There was an increasing trend in the daily COVID-19 confirmed cases in Nigeria. During the lockdown, the growth rate of COVID-19 in Nigeria was 5.85 (R2=0.728, p2=0.625, pConclusions: An improvement in COVID-19 control measures and strict compliance with the COVID-19 recommended protocols are essential. A contingency plan is needed to provide care for the active cases in case the predicted target is realised.

Background Malaria in pregnancy has adverse effects on maternal and child health. Intermittent preventive treatment (IPTp) with three doses of Sulfadoxine/Pyrimethamine is an effective preventive measure for malaria in pregnancy. However, 24.0% of women use this prophylactic regimen in Ebonyi State. Previous studies have focused on the level of uptake with less attention given to factors influencing uptake. Therefore, we examined the predictors of IPTp uptake in the last pregnancy among women in Ebonyi State, Nigeria. Methods This was a community-based cross-sectional study among 340 women of reproductive age selected using multistage sampling technique. A semi-structured interviewer administered questionnaire was used to collect data on socio-demographic characteristics of respondents, IPTp uptake and reasons for not taking IPTp. Adherence was judged adequate if three or more doses of IPTp were taken, otherwise inadequate. Data were analyzed using descriptive statistics, Chi- square test and logistic regression model at 5% level of significance. Results Mean age of respondents was 28.8 ± 5.2 years, 96.5% were married, 19.4% had tertiary education, and 11.2% were from polygamous family. Uptake of IPTp was 74.2%. The level of IPTp uptake was 12.5 and 41.0% among women with no formal and tertiary education respectively. A similar pattern of IPTp uptake was observed among women from monogamous (38.0%) and polygamous (39.5%) families. Women education, husband education and family type were associated with uptake of IPTp, however only husband education remained a predictor of uptake. Women whose husband had secondary education (aOR = 4.1, 95%CI: 1.66–10.06) and tertiary education (aOR = 4.8, 95%CI: 1.76–12.90) were more likely to have IPTp uptake than those whose husbands had below secondary education. Conclusion Adequate IPTp uptake among women in their last pregnancy was below WHO recommendation. Intervention aimed at improving couple’s education could facilitate increase in IPTp uptake in Ebonyi State.

Objective Fertility is a count data usually rightly skewed and exhibiting large number of zeros than the distributional assumption of the generalized linear models (GLMs). This study examined the robustness of zero-augmented models over GLMs to fit fertility data across regions in Nigeria. The 2013 Nigeria Demographic and Health Survey data were used. The fertility models fitted included: Poisson, negative binomial, zero-inflated Poisson, zero-inflated negative binomial, hurdle Poisson and hurdle negative binomial. Akaike Information Criteria (AIC) and Bayesian Information Criteria (BIC) were used to identify the model with best fit (α = 0.05). Results The percentage of zero count in the fertility responses were 21.3, 23.9, 31.1, 30.7, 37.6 and 42.4 in North West, North East, North Central, South West, South South and South East regions respectively. In all the six regions in Nigeria, the zero-augmented models were better than the generalized linear models except for North Central. Extensively, the zero-augmented negative binomial based models were of better fit than their Poisson based counterparts; or in rare cases maybe indistinguishable. However, specific family of zero-augmented model is recommended for each region in Nigeria.

Childhood diarrhea remains a problem in countries like Nigeria where access to potable water, good hygiene and sanitation are lacking. Maternal education is an important determinant of health status of under-five children. Very few studies have investigated the relationship between maternal education and diarrhea in children in Nigeria. Therefore, this study was implemented to fill the gap. The study design was cross-sectional and 2013 National Survey was used. Children aged 0-24 months were investigated and the dependent variable was diarrhea status of the index child in the last two weeks prior the survey. The main independent variable was maternal education. Data were analyzed using Chi-square and Logistic regression models (α=0.05). Diarrhea prevalence was 13.7% and higher (15.5%) among children of women who have no formal education, and mothers living in the North East region of Nigeria experienced the highest prevalence (26.4%). Children whose mothers had no formal education were 2.69(CI= 1.800-4.015, p