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Abstract Background The Corona Virus Disease 2019 (COVID-19) pandemic overwhelmed health systems and disrupted the delivery of health services globally. Community Health Workers (CHWs) play a critical role in linking communities to health systems, supporting the prevention and control of diseases in many low- and middle-income countries. However, their roles, barriers, and facilitators in the response and control of the COVID-19 pandemic have not been well documented. We described the roles of CHWs in the COVID-19 response, including the barriers and facilitators. Methods A cross-sectional study design was used to assess the COVID-19 response in the Democratic Republic of Congo (DRC), Nigeria, Senegal, and Uganda. This involved 110 key informant interviews with policymakers, health facility managers, district health managers, and CHWs to understand the role of CHWs in the COVID 19 response, selected purposively. The total sample size was based on information saturation in each of the countries. A document review on the COVID-19 response was also conducted. We searched Google, Google Scholar, and PubMed for published and grey literature. Data from the selected documents were extracted into a Google master matrix in MS Excel and analyzed thematically. Results In COVID-19 Control, CHWs supported community-based surveillance, contact tracing, risk communication, community mobilization, and home-based care. To support the continuity of other non-COVID-19 services, the CHWs conducted community mobilization, sensitizations, outreaches, referrals, and patient follow-ups. CHWs were challenged by movement restrictions, especially in the initial stages of the lockdown, inadequate PPE, increased workload, low allowances, and motivation. CHW were facilitated by trainings, the development of guidelines, development partners’ support/funding, and the provision of personal protective equipment (PPE) and tools. Conclusion CHWs supported both the COVID-19 control and continuity of non-COVID-19 health care during the COVID-19 pandemic. CHWs are a critical resource that must be adequately supported to build resilient health systems.

Abstract Background The COVID-19 pandemic control strategies disrupted the smooth delivery of essential health services (EHS) globally. Limited evidence exists on the health systems lens approach to analyzing the challenges encountered in maintaining EHS during the COVID-19 pandemic. This study aimed to identify the health system challenges encountered and document the mitigation strategies and adaptations made across geopolitical zones (GPZs) in Nigeria. Methods The national qualitative survey of key actors across the six GPZs in Nigeria involved ten states and the Federal Capital Territory (FCT) which were selected based on resilience, COVID-19 burden and security considerations. A pre-tested key informant guide was used to collect data on service utilization, changes in service utilization, reasons for changes in primary health centres’ (PHCs) service volumes, challenges experienced by health facilities in maintaining EHS, mitigation strategies implemented and adaptations to service delivery. Emerging sub-themes were categorized under the appropriate pillars of the health system. Results A total of 22 respondents were interviewed. The challenges experienced in maintaining EHS cut across the pillars of the health systems including: Human resources shortage, shortages in the supply of personal protective equipments, fear of contracting COVID-19 among health workers misconception, ignorance, socio-cultural issues, lockdown/transportation and lack of equipment/waiting area (. The mitigation strategies included improved political will to fund health service projects, leading to improved accessibility, affordability, and supply of consumables. The health workforce was motivated by employing, redeploying, training, and incentivizing. Service delivery was reorganized by rescheduling appointments and prioritizing some EHS such as maternal and childcare. Sustainable systems adaptations included IPC and telehealth infrastructure, training and capacity building, virtual meetings and community groups set up for sensitization and engagement. Conclusion The mitigation strategies and adaptations implemented were important contributors to EHS recovery especially in the high resilience LGAs and have implications for future epidemic preparedness plans.

The introduction of vaccines marked a game changer in the fight against COVID-19. In sub-Saharan Africa, studies have documented the intention to vaccinate and the uptake of COVID-19 vaccines. However, little is documented about how sex differences could have impacted COVID-19 vaccination. We conducted a multi-country cross-sectional study to assess the sex differences in COVID-19 vaccine uptake and intention to vaccinate in the Democratic Republic of Congo (DRC), Nigeria, Senegal, and Uganda. This study involved analysis of data from mobile surveys conducted between March and June 2022 among nationally constituted samples of adults in each country. Bivariate and multivariable logistic regression models were run. The self-reported uptake of COVID-19 vaccines was not significantly different between males and females (p = 0.47), while the intention to vaccinate was significantly higher among males (p = 0.008). Among males, obtaining COVID-19 information from health workers, testing for COVID-19, and having high trust in the Ministry of Health were associated with higher vaccination uptake. Among females, having high trust in the government was associated with higher vaccination uptake. For intention to vaccinate, males who resided in semi-urban areas and females who resided in rural areas had significantly higher vaccination intention compared to their counterparts in urban areas. Other factors positively associated with vaccination intention among males were trust in the World Health Organization and perceived truthfulness of institutions, while males from households with a higher socio-economic index and those who had declined a vaccine before had a lower vaccine intention. Overall, the factors differentiating vaccine uptake and intention to vaccinate among males and females were mostly related to trust in government institutions, perceived truthfulness of institutions, and respondent's residence. These factors are key in guiding the tailoring of interventions to increase COVID-19 vaccine uptake in sub-Saharan Africa and similar contexts.

Abstract Background Rapid urbanization in Nigerian cities may lead to localized variations in malaria transmission, particularly with a higher burden in informal settlements and slums. However, there is a lack of available data to quantify the variations in transmission risk at the city level and inform the selection of appropriate interventions. To bridge this gap, field studies will be undertaken in Ibadan and Kano, two major Nigerian cities. These studies will involve a blend of cross-sectional and longitudinal epidemiological research, coupled with longitudinal entomological studies. The primary objective is to gain insights into the variation of malaria risk at the smallest administrative units, known as wards, within these cities. Methods/results The findings will contribute to the tailoring of interventions as part of Nigeria’s National Malaria Strategic Plan. The study design incorporates a combination of model-based clustering and on-site visits for ground-truthing, enabling the identification of environmental archetypes at the ward-level to establish the study’s framework. Furthermore, community participatory approaches will be utilized to refine study instruments and sampling strategies. The data gathered through cross-sectional and longitudinal studies will contribute to an enhanced understanding of malaria risk in the metropolises of Kano and Ibadan. Conclusions This paper outlines pioneering field study methods aimed at collecting data to inform the tailoring of malaria interventions in urban settings. The integration of multiple study types will provide valuable data for mapping malaria risk and comprehending the underlying determinants. Given the importance of location-specific data for microstratification, this study presents a systematic process and provides adaptable tools that can be employed in cities with limited data availability.

Abstract Introduction The coronavirus (COVID 19) pandemic is one of the most terrifying disasters of the twenty-first century. The non-pharmaceutical interventions (NPIs) implemented to control the spread of the disease had numerous positive consequences. However, there were also unintended consequences—positively or negatively related to the nature of the interventions, the target, the level and duration of implementation. This article describes the unintended economic, Psychosocial and environmental consequences of NPIs in four African countries. Methods We conducted a mixed-methods study in the Democratic Republic of Congo (DRC), Nigeria, Senegal and Uganda. A comprehensive conceptual framework, supported by a clear theory of change was adopted to encompass both systemic and non-systemic interventions. The data collection approaches included: (i) review of literature; (ii) analysis of secondary data for selected indicators; and (ii) key informant interviews with policy makers, civil society, local leaders, and law enforcement staff. The results were synthesized around thematic areas. Results Over the first six to nine months of the pandemic, NPIs especially lockdowns, travel restrictions, curfews, school closures, and prohibition of mass gathering resulted into both positive and negative unintended consequences cutting across economic, psychological, and environmental platforms. DRC, Nigeria, and Uganda observed reduced crime rates and road traffic accidents, while Uganda also reported reduced air pollution. In addition, hygiene practices have improved through health promotion measures that have been promoted for the response to the pandemic. All countries experienced economic slowdown, job losses heavily impacting women and poor households, increased sexual and gender-based violence, teenage pregnancies, and early marriages, increased poor mental health conditions, increased waste generation with poor disposal, among others. Conclusion Despite achieving pandemic control, the stringent NPIs had several negative and few positive unintended consequences. Governments need to balance the negative and positive consequences of NPIs by anticipating and instituting measures that will support and protect vulnerable groups especially the poor, the elderly, women, and children. Noticeable efforts, including measures to avoid forced into marriage, increasing inequities, economic support to urban poor; those living with disabilities, migrant workers, and refugees, had been conducted to mitigate the negative effects of the NIPs.

BackgroundAfrican countries leveraged testing capacities to enhance public health action in response to the COVID-19 pandemic. This paper describes experiences and lessons learned during the improvement of testing capacity throughout the COVID-19 response in Senegal, Uganda, Nigeria, and the Democratic Republic of the Congo (DRC).MethodsThe four countries’ testing strategies were studied using a mixed-methods approach. Desk research on COVID-19 testing strategies was conducted and complemented by interviewing key informants. The findings were synthesized to demonstrate learning outcomes across the four countries.ResultsThe four countries demonstrated severely limited testing capacities at the onset of the pandemic. These countries decentralized COVID-19 testing services by leveraging preexisting laboratory systems such as PCR and GeneXpert used for the diagnosis of tuberculosis (TB) to address this gap and the related inequities, engaging the private sector, establishing new laboratories, and using rapid diagnostic tests (RDTs) to expand testing capacity and reduce the turnaround time (TAT). The use of digital platforms improved the TAT. Testing supplies were sourced through partners, although access to global markets was challenging. Case detection remains suboptimal due to high costs, restrictive testing strategies, testing access challenges, and misinformation, which hinder the demand for testing. The TAT for PCR remained a challenge, while RDT use was underreported, although Senegal manufactured RDTs locally. Key findings indicate that regionally coordinated procurement and manufacturing mechanisms are required, that testing modalities must be simplified for improved access, and that the risk-based testing strategy limits comprehensive understanding of the disease burden.ConclusionAlthough testing capacities improved significantly during the pandemic, case detection and access to testing remained suboptimal. The four countries could benefit from further simplification of testing modalities and cost reduction. Local manufacturing and pooled procurement mechanisms for diagnostics are needed for optimal pandemic preparedness and response.

Abstract Background The COVID-19 pandemic has impacted the world negatively with huge health and socioeconomic consequences. This study estimated the seasonality, trajectory, and projection of COVID-19 cases to understand the dynamics of the disease spread and inform response interventions. Method Descriptive analysis of daily confirmed COVID-19 cases from January 2020 to 12th March 2022 was conducted in four purposefully selected sub-Saharan African countries (Nigeria, Democratic Republic of Congo (DRC), Senegal, and Uganda). We extrapolated the COVID-19 data from (2020 to 2022) to 2023 using a trigonometric time series model. A decomposition time series method was used to examine the seasonality in the data. Results Nigeria had the highest rate of spread (β) of COVID-19 (β = 381.2) while DRC had the least rate (β = 119.4). DRC, Uganda, and Senegal had a similar pattern of COVID-19 spread from the onset through December 2020. The average doubling time in COVID-19 case count was highest in Uganda (148 days) and least in Nigeria (83 days). A seasonal variation was found in the COVID-19 data for all four countries but the timing of the cases showed some variations across countries. More cases are expected in the 1st (January-March) and 3rd (July–September) quarters of the year in Nigeria and Senegal, and in the 2nd (April-June) and 3rd (October-December) quarters in DRC and Uganda. Conclusion Our findings show a seasonality that may warrant consideration for COVID-19 periodic interventions in the peak seasons in the preparedness and response strategies.

Abstract Background Private entities play a major role in health globally. However, their contribution has not been fully optimized to strengthen delivery of public health services. The COVID-19 pandemic has overwhelmed health systems and precipitated coalitions between public and private sectors to address critical gaps in the response. We conducted a study to document the public and private sector partnerships and engagements to inform current and future responses to public health emergencies. Methods This was a multi-country cross-sectional study conducted in the Democratic Republic of Congo, Nigeria, Senegal and Uganda between November 2020 and March 2021 to assess responses to the COVID-19 pandemic. We conducted a scoping literature review and key informant interviews (KIIs) with private and public health sector stakeholders. The literature reviewed included COVID-19 country guidelines and response plans, program reports and peer-reviewed and non-peer-reviewed publications. KIIs elicited information on country approaches and response strategies specifically the engagement of the private sector in any of the strategic response operations. Results Across the 4 countries, private sector strengthened laboratory systems, COVID-19 case management, risk communication and health service continuity. In the DRC and Nigeria, private entities supported contact tracing and surveillance activities. Across the 4 countries, the private sector supported expansion of access to COVID-19 testing services through establishing partnerships with the public health sector albeit at unregulated fees. In Senegal and Uganda, governments established partnerships with private sector to manufacture COVID-19 rapid diagnostic tests. The private sector also contributed to treatment and management of COVID-19 cases. In addition, private entities provided personal protective equipment, conducted risk communication to promote adherence to safety procedures and health promotion for health service continuity. However, there were concerns related to reporting, quality and cost of services, calling for quality and price regulation in the provision of services. Conclusions The private sector contributed to the COVID-19 response through engagement in COVID-19 surveillance and testing, management of COVID-19 cases, and health promotion to maintain health access. There is a need to develop regulatory frameworks for sustainable public–private engagements including regulation of pricing, quality assurance and alignment with national plans and priorities during response to epidemics.

Abstract Background Physiotherapy internship in Nigeria was inaugurated in 1994 to allow continuous learning in the clinical setting, connecting theoretical knowledge and workplace practice. The internship program has not been evaluated over the years. The aim of study was to assess physiotherapists’ perceptions of the internship in Nigeria in terms of expectations, experiences, and outcomes. Methods A mixed method design of a cross-sectional survey and focus group discussion (FGD) was utilized. An adapted questionnaire was used for the survey. Data was assessed using descriptive statistics and content thematic analysis. Results The mean age of the physiotherapists who participated in the survey (147 males; 116 females) and FGD (7 males; 2 females) were 27.4 ± 2.5 and 28.8 ± 2.3 years, respectively. Most participants in the survey perceived their internship experience as good (97.7%), the supervision received as adequate (76%), and the outcomes of internship in terms of usefulness as useful (76%). The overall perception of physiotherapy internship in Nigeria was rated as good by 51% and fair by 47% of participants. However, responders in the FGD reported negative experiences including inadequate or lack supervision. They also reported that they were not formally prepared for internship by their training institutions or receiving health institutions before beginning internship. Conclusion Physiotherapy internship in Nigeria was perceived as deficient in structural organization and supervision of the interns. The outcome of internship program was perceived as good even though the experiences were negative.

Abstract Background Nigeria’s healthcare system capacity to stem the increasing trend in hypertension is limited in coverage, scope and manpower. Use of trained community-based care providers demonstrated to be an effective complement in improving access to, and supporting healthcare delivery has not been adequately examined for hypertension care in Nigeria. This study is proposed to evaluate the effectiveness of using trained community-oriented resource persons (CORPs) to improve hypertension control in Nigeria. Methods An intervention study will be conducted in three states using a mixed method design. First is a baseline survey using a semi-structured pre-tested questionnaire to collect information on demographics, clinical data, knowledge, occurrence and risk factors of hypertension among 1704 adults ≥18 years. Focus group discussions (FGD) and key informant interviews (KII) will be conducted to explore a community’s experience of hypertension, challenges with hypertension management and support required to improve control in 10 selected communities in each state. The second is a cluster-randomized controlled trial to evaluate effect of a package on reduction of blood pressure (BP) and prevention of cardiovascular (CVD) risk factors among 200 hypertensive patients to be followed up in intervention and control arms over a 6-month period in each state. The package will include trained CORPs conducting community-based screening of BP and referral, diagnosis confirmation and initial treatment in the health facility, followed by monthly home-based follow-up care and provision of health education on hypertension control and healthy lifestyle enhanced by phone voice message reminders. In the control arm, the usual care (diagnosis, treatment and follow-up care in hospital of a patient’s choice) will continue. Third, an endline survey will be conducted in both intervention and control communities to evaluate changes in mean BP, control, knowledge and proportion of other CVD risk factors. In addition, FGD and KII will be used to assess participants’ perceived quality and acceptability of the interventions as delivered by CORPs. Discussion This research is expected to create awareness, improve knowledge, perception, behaviours, attitude and practices that will reduce hypertension in Nigeria. Advocacy for buy-in and scale up of using CORPs in hypertension care by the government is key if found to be effective. Trial registration PACTR Registry PACTR202107530985857 . Registered on 26 July 2021.

We report the epidemiology of Lassa fever in Bauchi State, a disease-endemic region, in Nigeria. Since 2015, major increases in Lassa fever attack rate and in the case-fatality rate have occurred in this state. A delay in seeking care by a case-patient for >7 days after symptom onset was the major predictor of death.

Globally, vaccination has been known to reduce the burden of infectious diseases such as COVID-19, with its effectiveness relying on public acceptance and widespread uptake. Despite the efforts put into the rapid development of SARS-COV-2 vaccines, uptake remains a major challenge in many countries especially those with large population dynamics like Nigeria. Most studies in Nigeria have assessed the uptake of the SARS-COV-2 vaccine among groups of people without consideration for ethno-cultural diversity. This study therefore explored COVID-19 vaccine uptake, its determinants and future intention among adult Nigerians in the six geopolitical zones of Nigeria. This was a cross-sectional survey using a Computer Assisted Telephone Interview. The study enrolled 1148 adults from one representative state across each of the six geopolitical zones that had a high COVID-19 burden. Trained research assistants interviewed consenting respondents using a pretested semi-structured questionnaire configured in Survey CTO between May and June 2022. Descriptive statistics were provided as means for continuous variables, while categorical variables were expressed as frequencies and percentages. Prevalence ratios were used as the measure of association. Respondents' age was 37.8±13.4 years, 53.9% were men and majority (65.2%) from southern Nigeria. About half (50.9%) of the respondents had not received vaccination, 29.7% were fully vaccinated, and 19.3% had incomplete dose. Majority (65.5%) of the respondents in the Northern states had not received SARS-COV-2 vaccine. Participants' age, sex, place of residence, occupation, religion, and region of residence were associated with vaccine uptake (p

In 2020 and 2021, Governments across the globe instituted school closures to reduce social interaction and interrupt COVID-19 transmission. We examined the consequences of school closures due to COVID-19 across four sub-Saharan African countries: the Democratic Republic of Congo (DRC), Nigeria, Senegal, and Uganda. We conducted a qualitative study among key informants including policymakers, school heads, students, parents, civil society representatives, and local leaders. The assessment of the consequences of school closures was informed by the Diffusion of Innovations theory which informed the interview guide and analysis. Interview transcripts were thematically analysed. Across the four countries, schools were totally closed for 120 weeks and partially closed for 48 weeks. School closures led to: i) Desirable and anticipated consequences: enhanced adoption of online platforms and mass media for learning and increased involvement of parents in their children's education. ii) Desirable and unanticipated consequences: improvement in information, communication, and technology (ICT) infrastructure in schools, development and improvement of computer skills, and created an opportunity to take leave from hectic schedules. iii) Undesirable anticipated consequences: inadequate education continuity among students, an adjustment in academic schedules and programmes, and disrupted student progress and grades. iv) Undesirable unanticipated: increase in sexual violence including engaging in transactional sex, a rise in teenage pregnancy, and school dropouts, demotivation of teachers due to reduced incomes, and reduced school revenues. v) Neutral consequences: engagement in revenue-generating activities, increased access to phones and computers among learners, and promoted less structured learning. The consequences of school closures for COVID-19 control were largely negative with the potential for both short-term and far-reaching longer-term consequences. In future pandemics, careful consideration of the type and duration of education closure measures and examination of their potential consequences in the short and long term is important before deploying them.

Nigerian urban slums have a high population of infants with suboptimal vaccination despite previous interventions. Older women traditionally play supervisory roles in infant care in Nigeria but their influence is untapped in infant vaccination. This study sought to determine if training of older women (≥35 years) in urban slum communities in Ibadan, South west Nigeria, and involving them in infant vaccination will improve infant vaccination timeliness and completion. This was a randomized experimental community study and pregnant women in their third trimester, residing in seven urban slum communities were randomized using their antenatal clinics (ANCs) into intervention (six ANCs) and control groups (six ANCs). The older women who will supervise the care of the infants of pregnant women in the intervention group had seven sessions of training on the importance of infant vaccination timeliness and completion. The vaccinations of the infants from both groups were compared from birth till 9 months. Data were analyzed using descriptive statistics and Chi square test at α = 0.05. There were 96 older women, 198 pregnant women (105 in intervention group and 93 controls) and 202 infants (109 in intervention group and 93 controls). Infants in the intervention group (67.9%) significantly had both timely and complete vaccinations compared with those in the control group (36.6%). Vaccines given at birth were the least timely in both groups. More infants whose older women caregiver were married had timely and complete vaccinations. Also, a higher proportion of male infants, low birth weight babies and infants with older women caregiver with at most two children had timely and completed vaccinations but these were not statistically significant. Training of older women caregivers improved infant vaccination timeliness and completion in these urban slum communities. This model may improve infant vaccination in other similar urban slum settings.

Abstract Background The COVID-19 pandemic presented a myriad of challenges for the health workforce around the world due to its escalating demand on service delivery. A motivated health workforce is critical to effectual emergency response and in some settings, incentivizing health workers motivates them and ensures continuity in the provision of health services. We describe health workforce experiences with incentives and dis-incentives during the COVID-19 response in the Democratic Republic of Congo (DRC), Senegal, Nigeria, and Uganda. Methods This is a multi-country qualitative research study involving four African countries namely: DRC, Nigeria, Senegal, and Uganda which assessed the workplace incentives instituted in response to the COVID-19 pandemic. Key informant interviews (n = 60) were conducted with staff at ministries of health, policy makers and health workers. Interviews were virtual using the telephone or Zoom. They were audio recorded, transcribed verbatim, and analyzed thematically. Themes were identified and quotes were used to support findings. Results Health worker incentives included (i) financial rewards in the form of allowances and salary increments. These motivated health workers, sustaining the health system and the health workers’ efforts during the COVID-19 response across the four countries. (ii) Non-financial incentives related to COVID-19 management such as provision of medicines/supplies, on the job trainings, medical care for health workers, social welfare including meals, transportation and housing, recognition, health insurance, psychosocial support, and supervision. Improvised determination and distribution of both financial and non-financial incentives were common across the countries. Dis-incentives included the lack of personal protective equipment, lack of transportation to health facilities during lockdown, long working hours, harassment by security forces and perceived unfairness in access to and inadequacy of financial incentives. Conclusion Although important for worker motivation, financial and non-financial incentives generated some dis-incentives because of the perceived unfairness in their provision. Financial and non-financial incentives deployed during health emergencies should preferably be pre-determined, equitably and transparently provided because when arbitrarily applied, these same financial and non-financial incentives can potentially become dis-incentives. Moreover, financial incentives are useful only as far as they are administered together with non-financial incentives such as supportive and well-resourced work environments. The potential negative impacts of interventions such as service delivery re-organization and lockdown within already weakened systems need to be anticipated and due precautions exercised to reduce dis-incentives during emergencies.

Introduction The COVID-19 pandemic has had a substantial negative impact on the utilisation of essential health services (EHS) globally, especially in resource-limited settings such as Nigeria. High maternal deaths associated with low access to and utilisation of EHS such as antenatal care (ANC) and skilled birth attendants (SBAs) remain a concern during the COVID-19 era. The study assessed the COVID-19 pandemic effects on ANC and SBA utilisation across regions in Nigeria.Methods Monthly data on ANC and SBA between January 2017 and July 2021 were obtained from the Federal Ministry of Health database. An interrupted time-series analysis, implemented using the Prophet model, was conducted to compare the regional variation of outcomes during the COVID-19 pandemic. Average percentage changes (PC) between the observed and predicted outcomes including their 95% CI were reported.Results From March 2020 to July 2021, the number of ANC visits was significantly lower than expected by a 16%–43% change in five of the six regions in Nigeria. The highest significant reduction was in North-West (PC=−43.4; 95% CI: −52.6 to –34.1) and the least in South-West (PC=−15.5; 95% CI: −24.8 to –6.1), with no significant change in the South-East. The number of deliveries by SBA was significantly lower than expected by a 18%–43% change in all the regions (p

Abstract Background One of the strategies for improving vaccination uptake is to make communities understand the importance of immunization and this is expected to drive the demand for vaccines. Building the capacity of older women who supervise child care in Africa may improve infant vaccination in underserved communities. This study determined the impact of training of older women on their knowledge and support for infant vaccination in selected urban slum communities in Ibadan, Nigeria. Methods This was a before-and-after study that enrolled women aged ≥35 years. They were trained with a manual and short video using participatory learning methods over an 8 month period. The content of their training includes importance of immunization timeliness and completion, how vaccines work and how to be advocates and supporters of infant vaccination. Their knowledge and support for infant vaccination at baseline were compared with post training values using Student’s t test and Chi square test with the level of significance set at 5%. Results There were 109 women with mean age 55.8 ± 11.6. they had a mean of 5.7 ± 2.1 training sessions. At the end of the training, their knowledge about infant vaccination and the support they give to it increased from 4.8 ± 3.8 to 10.7 ± 0.6, and 3.1 ± 3.5 to 8.1 ± 1.7 respectively. Those with good knowledge about infant vaccination increased significantly from 37(33.9%) to 82(82.8%), while those with good support for the same increased from 31(28.4%) to 85(85.9%). Women who were ≤ 64 years significantly had improved knowledge after the training compared to the older ones. Those with post secondary education had better knowledge and greater support for infant vaccination at baseline. However, there was no difference in the knowledge and support for infant vaccination among the women across the different educational levels after the training. Conclusions Participatory learning improved the knowledge about, and support for infant vaccination among older women supervising child care in these urban slum communities. Similar training may be extended to comparable settings in order to improve demand for infant vaccination.

Abstract 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.

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.

The COVID-19 pandemic has affected all dimensions of lives and has become a social problem as it continues to spread widely through the continuous interactions of people in public spaces where they earn a living. Curbing the spread of COVID-19 requires restrictions in these public spaces, however, the compliance to these measures depends largely on the understanding and interpretations of COVID 19 by users of these public spaces. This study examined the contextual interpretations of public space users about COVID-19 prevention in Ibadan Metropolis, Oyo State. The study was a rapid ethnographic survey in selected public spaces (markets and commercial motor parks) in Ibadan metropolis. Data were collected through participant observation, key informant interviews (3 females; 3 males) and in-depth interviews (30) with, traders, head porters, clients/buyers and commercial vehicle drivers in these public spaces. Interviews conducted were transcribed, sorted into themes using Atlas-ti 7.5.7 and subjected to interpretive-content analysis. Findings revealed that some respondents felt COVID-19 was brought into Nigeria by rich frequent global voyagers, others felt it was through “uncultured” sexual life or wrath of God. Some also doubted the existence of the disease and many of the respondents perceived COVID-19 as a disease reported by the government or a political propaganda to siphon funds. The users of the public spaces in Ibadan Metropolis have variegated perception about the existence and severity of this rapidly spreading virus and this has grave implications for COVID-19 control in the State. Thus, regular interaction with public space users are essential for control efforts.

INTRODUCTION: Effective diseases surveillance remains an important operational tool in countries with recurrent epidemic prone diseases (EPDs). In Nigeria, insufficient knowledge among Health Care Workers (HCWs) on Integrated Disease Strategy and Response Strategy (IDSR) have been documented. This study assessed knowledge and attitude of HCWs towards IDSR strategy for EPDs at the Primary Health Care (PHC) level in Oyo State, Nigeria. METHODS: a cross-sectional facility based study using an interviewer-administered questionnaire was used to obtain information from 531 HCWs. In addition, 7 Key Informant Interviews was conducted. Discrete data were summarized as proportions while chi-square test was used to assess association between variables. A logistic regression model was used to assess predictors of knowledge of HCWs. All statistical significance was set at 5%. RESULTS: mean age of respondents was 42 , 8.1 years with female preponderance (86.1%). Community Health Extension Workers (CHEWs) (36.9%) constituted the highest proportion of HCWs. About 70% and 90% of HCWs had good knowledge of EPDs and IDSR surveillance data flow respectively. Majority of HCWs 333(67.3%) knew how to use IDSR form 003 but less than 10% knew how to use other IDSR forms. The majority of HCWs {492(99.4%) and 345(69.7%)} agreed that reporting EPDs is necessary and IDSR tools are simple to use. Number of years post basic qualification was a predictor of HCWs' knowledge (AOR: 1.6; 95% CI: 1.0-2.3). CONCLUSION: this study showed poor knowledge on the use of IDSR forms although majority of HCWs had good knowledge and positive attitude towards IDSR strategy for EPDs. Thus, regular evaluation of health workers' knowledge and attitude towards IDSR strategy as a performance function of the surveillance system is recommended.