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An outbreak of Ebola virus disease (EVD) (Sudan virus) was first reported in the Republic of Uganda on September 20, 2022. As of November 17, 2022, 151 confirmed cases have been reported, including 55 deaths (with a case fatality rate among confirmed cases of 39%).During the EVD outbreak in 2013–2016, international travel played a significant role in the spread of the disease across national borders. During that time, several tasks requiring improvement were identified in the World Health Organization (WHO) Southeast Asia Region (SEAR), including inadequate risk communication and risk assessment, data management gaps for surveillance purposes, inadequate capacity in molecular diagnostic techniques, lack of adequate planning for a surge of cases, and inadequate isolation rooms.It is therefore recommended that all countries of the WHO SEAR revisit their level of Ebola preparedness and address existing gaps. The emergence and rapid global spread of coronavirus disease 2019 (COVID-19) have reiterated that the world has become a global village. This was confirmed by the spread of the monkeypox virus with cases reported in the WHO SEAR. Therefore, given the weak health infrastructure in the region, complacency could wreak havoc on the healthcare system if another epidemic emerges without an adequate level of preparedness.

Abstract Introduction Muslims fast every year during the month of Ramadan from dawn until dusk. This study examined mental well‐being and correlating factors among Nigerian adults who observed Ramadan intermittent fasting (RIF). Methods A validated generalized anxiety disorder‐2 and Patient Health Questionnaire‐2, the four‐item spiritual well‐being index, and the Islamic intrinsic religiosity questionnaire were used to collect data about mental well‐being (depression, anxiety), spirituality, and intrinsic religiosity through a web‐based survey between the May 9, 2021 (27th of Ramadan, 1442) and the June 4, 2021 (29th of Shawwal, 1442). We studied the mental well‐being of respondents over a period of 4 weeks before Ramadan (BR) and during the 4 weeks of Ramadan between the April 12, 2021 and the May 12, 2021(DR). Multinomial regression analysis was used to determine the factors associated with depression and anxiety. This research did not receive any grant or funding. Results A total of 770 adult Nigerians who observed RIF study were included in this cross‐sectional study. When compared to mental well‐being BR, observing RIF by Nigerian adult respondents was associated with a significant improvement in their mental well‐being. A higher proportion of respondents felt less depressed DR (61.3% vs. 56.5%. < .001). Interest and pleasure in doing things improved DR than BR (p= 0.007) and respondents felt less nervous and anxious (60.7% vs. 57.1%, respectively; p

BackgroundCoronavirus disease 2019 (COVID-19) has emerged as an important cause of morbidity and mortality worldwide. The aim of this study is to identify the clinical predictors of mortality among patients with COVID-19 pneumonia during first and second waves in a treatment center in northwestern Nigeria.MethodsThis was a retrospective cohort study of 195 patients hospitalized with COVID-19 between April 2020 to March 2021 at a designated COVID-19 isolation center in Kano State, Northwest Nigeria. Data were summarized using frequencies and percentages. Unadjusted odds ratios and 95% confidence intervals and p-values were obtained. To determine independent determinants of mortality, we performed a stepwise multivariate logistic regression model.ResultsOf 195 patients studied, 21(10.77%) patients died. Males comprised 158 (81.03%) of the study population. In the adjusted stepwise logistic regression analysis, age>64 years (OR = 9.476, 95% CI: 2.181-41.165), second wave of the pandemic (OR = 49.340, 95% CI:6.222-391.247), cardiac complications (OR = 24.984, 95% CI: 3.618-172.508), hypertension (OR = 5.831, 95% CI:1.413-24.065) and lowest systolic blood pressure while on admission greater than or equal to 90mmHg were independent predictors of mortality (OR = 0.111, 95%CI: 0.021-0.581).ConclusionStrategies targeted to prioritize needed care to patients with identified factors that predict mortality might improve patient outcome.

Monkeypox is a viral zoonosis caused by the monkeypox virus, an enveloped, double-stranded DNA virus belonging to the Orthopoxvirus genus in the Poxviridae family. Monkeypox has become a disease of global public health significance. Pregnant women are unfortunately among the those at an increased risk for exposure to monkeypox because their immune system is altered during pregnancy. They may also be at risk for more severe disease or a worse outcome than others. During pregnancy or while breastfeeding when consideration is given for pre-exposure or postexposure vaccination, nonreplicating (Modivied Vaccinia Ankara – Bavarian Nordic) or minimally replicating (LC16, KM Biologics) vaccines are preferred. The ACAM2000 vaccine is contraindicated in pregnancy because it contains live virus particles that can cause fetal vaccinia and fetal death. There are no data to support the use of tecovirimat in pregnant women. However, no fetal adverse effects were noticed when tecovirimat was used in animal studies.

Background: Mycobacterium tuberculosis with resistance to first line and second line anti tuberculous drugs is a serious setback in the treatment of tuberculosis (TB). The COVID-19 pandemic constitutes a serious threat that could unwind the recent gains made thus far in the control of tuberculosis. This study aims to explore the pattern of drug resistant tuberculosis (DRTB) in our institution. We also aimed to explore the changing trends of TB in the era of the COVID-19 pandemic. Methods: This descriptive study included all DRTB patients admitted and managed in the hospital between January 2018 and December 2020. We compare TB case detection in the facility before and after COVID-19 pandemic. Drug susceptibility testing were expressed as frequencies and percentages. Results: The study found that there was 66.03%, 45.09% and 77.78% drop in case detection of drug-sensitive TB (DSTB), DRTB and Fluoroquinolone (FQ) resistant TB respectively in the year 2020 compared to 2019. The drop in cases was similar when the year 2020 was compared to 2018. Among the 132 patients in the cohort, resistance to isoniazid, fluoroquinolones and second-line injectable agents were reported as 23.48%, 12.88%, and 31.06% respectively. Conclusion: We question the potential reason why a drop in tuberculosis cases was observed in the year 2020 and we alert the Nigerian authorities that COVID-19 control efforts going hand-in-hand with intensified TB case finding and surveillance efforts and initiating proper TB treatment for persons with active TB are urgently needed.

Abstract Background As part of the Global Action Plan against antimicrobial resistance (AMR), countries are required to generate local evidence to inform context-specific implementation of national action plans against AMR (NAPAR). We aimed to evaluate the knowledge, attitude, and practice (KAP) regarding antibiotic prescriptions (APR) and AMR among physicians in tertiary hospitals in Nigeria, and to determine predictors of KAP of APR and AMR. Methods In this cross-sectional study, we enrolled physicians practicing in tertiary hospitals from all six geopolitical zones of Nigeria. Implementation of an antimicrobial stewardship programmes (ASP) by each selected hospital were assessed using a 12 item ASP checklist. We used a structured self-administered questionnaire to assess the KAP of APR and AMR. Frequency of prescriptions of 18 different antibiotics in the prior 6 months was assessed using a Likert’s scale. KAP and prescription (Pr) scores were classified as good (score ≥ 80%) or average/poor (score

Background: Globally, intensive care units (ICUs) are encountering emergence and spread of antibiotic-resistant pathogens, and for some pathogens, there are few therapeutic options available. Objectives: The study assessed prevalence, susceptibility pattern, and risk factors of carbapenem-resistant Enterobacteriaceae (CRE) infections among ICU patients in Kano, Nigeria. Materials and Methods: A descriptive cross-sectional study was used to study 190 patients admitted to the ICUs of two tertiary hospitals in Kano. Antibiotic susceptibility of isolated organisms was determined by disc diffusion technique. Suspected carbapenemase producers were further subjected to the modified Hodge test (MHT) method for confirmation. Results: A total of 76 out of the 190 samples yielded clinical isolates of Enterobacteriaceae as follows: 34 (44.7%) Escherichia coli, 19 (25%) Klebsiella pneumoniae, 3 (3.9%) Proteus mirabilis, 4 (5.3%) Enterobacter aerogenes, 3 (3.9%) Proteus vulgaris, 2 (2.6%) Citrobacter freundii, 2 (2.6%) Klebsiella ozaenae, 2 (2.6%) Klebsiella oxytoca, 2 (2.6%) Salmonella subsp. 3b, 2 (2.6%) Enterobacter agglomerans, 2 (2.6%) Enterobacter cloacae, and 1 (1.3%) Serratia odorifera. Screening the Enterobacteriaceae-positive samples for carbapenem resistance using ertapenem disc (10 μg) showed 8 samples (10.5%) as resistant while MHT gave a carbapenem resistance prevalence of 7.9% (6 out of 76). Based on multiplex polymerase chain reaction; the distributions of genotypes of the carbapenemase producers were as follows: Verona Integron Metallo-beta-lactamase (VIM) genes only (4 [50%]) New Delhi Metallo-beta-lactamase (NDM) genes only (2 [25%]), and 1 (12.5%) had Klebsiella pneumoniae carbapenemase (KPC) and VIM gene coexisting. Surgical procedure (P = 0.009) and history of recent admission (P = 0.001) were found to be risk factors for CRE. Conclusion: The study provided evidence of the presence of CRE infections among patients admitted to ICUs in the study centers. This underscores the need for effective infection prevention and control measures to avoid the spread of CRE in hospital setting.

Background: The emergence of drug-resistant tuberculosis (DRTB) has continued to pose a threat to public health in sub-Saharan Africa and globally. Despite the high burden of tuberculosis (TB) in Nigeria, there are paucity of data on the safety and efficacy of newer agents and repurposed drugs used in the treatment of DRTB. Methods: This prospective cohort study was conducted at a regional DRTB treatment center in Kano, Northwestern Nigeria. Descriptive statistics, Mann–Whitney U-test, and Chi-square or Fisher's exact test were used to analyze the data as appropriate. Results: The median age of the patients was 32 years (interquartile range 26–42 years). Of the 39 patients, 34 (87.18%) were males. The majority of the patients came from the rural areas 25 (64.10%). By 10 months of initiation of combination therapy, 25 (64.10%) of the patients were alive, culture negative and on treatment while 14 (35.90%) of the patients have died. Out of the 39 patients in the cohort, 26 (66.67%) patients had at least one serious adverse event. The most common serious adverse events were hematological disorders (13 [35.14%] of 37 events) and neurological disorders (11 [29.73%] of 37 events). Peripheral neuropathy (P < 0.0001), anemia (P = 0.029), and skin reaction (P = 0.021) occurred more frequently among linezolid interrupters. Conclusions: In conclusion linezolid-based combination therapy, with linezolid at a dose of 600mg daily is associated with satisfactory culture conversion rate by 10 months of therapy. However, linezolid may be associated with peripheral neuropathy that may warrant interruption of the drug.

IntroductionMalaria is the second leading cause of death in children after diarrheal disease, with low- and middle-income countries (LMICs) accounting for over 9 in 10 incidence and deaths. Widespread acceptance and uptake of the RTS,S vaccine, recently approved by the world health organization (WHO), is projected to significantly reduce malaria incidence and deaths. Therefore, we conducted this systematic review and meta-analysis with the aim to determine the malaria vaccine acceptance rate and the factors associated with acceptance.MethodsWe searched six databases including Google Scholar, PubMed, Cochrane, African Index Medicus, The Regional Office for Africa Library, and WHO Institutional Repository for Information Sharing (IRIS) to identify studies evaluating the malaria vaccine acceptance rate. This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Studies were included if they were original articles published in the English language in peer-reviewed journals and assessed the prevalence of willingness to accept a free malaria vaccine, and not qualitative. The risk of publication bias was checked using both Beggar's funnel plot and Egger's test, while the I2 statistic was used to assess the heterogeneity of the included studies. Study quality was determined using the Newcastle-Ottawa scale. A meta-analysis was performed using a random effects model to evaluate the pooled prevalence of malaria vaccine acceptance. The protocol for this article was registered prospectively on the International Prospective Register for Systematic Reviews (PROSPERO), with ID number CRD42022334282).ResultsOur analysis included 11 studies with a total sample size of 14, 666 participants. The aggregate malaria vaccine acceptance rate was 95.3% (95% CI:93.0%-97.2%). Among the general population, the acceptance rate was 96.3% (95% CI:92.0%-99.0%) and among mothers, it was 94.4% (95% CI:90.8%-97.2%). By country, Nigeria had the highest acceptance rate (97.6%, 95% CI:96.0%-98.8%), followed by Ghana (94.6%, 95% CI:93.8%-95.3%) and Tanzania (92.5%, 95% CI:84.4%-97.8%). Sociodemographic determinants of vaccine acceptance included place of residence, tribe, age, sex, occupation, and religion. Reasons for low acceptance included safety concerns, efficacy profile, vaccine's requirement for multiple injections, and poor level of awareness.ConclusionFuture efforts should be focused on identifying factors that may improve the actual uptake of the RTS,S vaccine in malaria-endemic communities.

Aims: Understanding of the perceived stress and coping strategies adopted by people is important for contemplating the consequences of a pandemic on mental health of people globally. In this study, we intended to assess the perceived stress status under quarantine/isolation globally during the COVID-19 pandemic.Methods: This is a multicentre, multinational cross-sectional study that recruited isolated/quarantined individuals suspected or confirmed to have COVID-19 to assess the psychological impact of the quarantine/isolation experience by answering a survey distributed online.Results: The study was conducted across 63 participating countries, gaining 1,871 valid responses. There was a higher proportion of female participants in the Moderate to High Perceived Stress Scores (MH-PSS) group compared to the Low Perceived Stress Score group (66.0 vs. 52.0%) and a higher proportion of individuals whose marital status was single had MH-PSS (57.1%). Also, individual's religion (Christian, Hindu, and Muslim), no formal education level, being exposed to a confirmed or suspected COVID-19 patient, being forced to be quarantined/isolated, uncomfortable feeling during quarantine period may significantly increase the risk of MH-PSS (p < 0.05).Conclusions: Many factors can predict stress in COVID-19 pandemic including female sex, being single, religion, no formal education, involuntary quarantine, location and reason of quarantine/isolation, and place of exposure.

BackgroundA pandemic of coronavirus disease 2019 (COVID-19) emerged and affected most of the world in early 2020. To inform effective public health measures we conducted a knowledge, attitude and practice (KAP) survey among a Hausa Muslim society in Nigeria in March 2020.MethodsThe study is an analytic cross-sectional survey with questionnaires administered to the general population including Health Care Workers (HCW) in Kano, Nigeria. Participants were recruited by convenience sampling following informed consent. The percentage of KAP scores were categorized as good and poor. Independent predictors of good knowledge of COVID 19 were ascertained using a binary logistic regression model.ResultsThe questionnaire was administered among urban 32.8%, peri-urban dwellers 32.4%, and to online participants 34.8%. The peri-urban and urban participants were given paper questionnaires. There were 886 study participants with mean age 28.58yrs [SD:10.25] (Interquartile range [IQR]:22yrs-32yrs), males 55.4% with 57.3% having had or were in tertiary education. Most participants were students 40% and civil servants 20%. The overall mean [standard deviation (SD)] for knowledge, attitude and practice scores expressed in percentage was 65.38%[SD15.90], 71.45% [SD14.10], and 65.04% [SD17.02] respectively. Out of the respondents, 270(30.47%) had good knowledge (GK), 158(17.8%) had good attitude (GA), and 230(25.96%) had good practice (GP) using cut-off scores of 75%, 86.5%, and 75% respectively. Over 48% did not agree COVID-19 originated from animals while 60% perceived the pandemic to be due to God's punishment. Also, 36% thought it was a man-made virus. When rating fear, most respondents [63.5%] had marked fear i.e. ≥ 7 out of 10 and 56% admitted to modifying their habits recently in fear of contracting the virus. As regards attitude to religious norms, 77.77% agreed on cancellation of the lesser pilgrimage as a measure to curb the spread of the disease while 23.64% admitted that greater pilgrimage (Hajj) should proceed despite the persistence of the ongoing pandemic. About 50% of the respondents insisted on attending Friday congregational prayers despite social distancing. One in four people still harbored stigma towards a person who has recovered from the virus. 28% felt some races are more at risk of the disease though 66% mentioned always practicing social distancing from persons coughing or sneezing. Almost 70% of respondents said they were willing to accept a vaccine with 39% saying they would be willing to pay for it if not publicly funded. In univariate analysis increasing age and having been ever married were associated with GK while tertiary education was associated with GA [Odds Ratio; 95% Confidence Interval] 2.66(1.79-3.95). Independent positive predictors of GK were those who were or had ever been married, those who had marked fear of COVID-19, and had modified their habits in the last three months. Those who had non-tertiary education and had the questionnaire administered as paper rather than online version had GK but age was not a predictor.ConclusionKnowledge of transmission and preventive measures should be improved in the general population cognizant of cultural norms and Islamic practices. The study highlights the importance of considering belief systems and perception in developing control measures against COVID-19.

IntroductionThe COVID-19 pandemic continues to overwhelm health systems across the globe. We aimed to assess the readiness of hospitals in Nigeria to respond to the COVID-19 outbreak.MethodBetween April and October 2020, hospital representatives completed a modified World Health Organisation (WHO) COVID-19 hospital readiness checklist consisting of 13 components and 124 indicators. Readiness scores were classified as adequate (score ≥80%), moderate (score 50-79.9%) and not ready (score ResultsAmong 20 (17 tertiary and three secondary) hospitals from all six geopolitical zones of Nigeria, readiness score ranged from 28.2% to 88.7% (median 68.4%), and only three (15%) hospitals had adequate readiness. There was a median of 15 isolation beds, four ICU beds and four ventilators per hospital, but over 45% of hospitals established isolation facilities and procured ventilators after the onset of COVID-19. Of the 13 readiness components, the lowest readiness scores were reported for surge capacity (61.1%), human resources (59.1%), staff welfare (50%) and availability of critical items (47.7%).ConclusionMost hospitals in Nigeria were not adequately prepared to respond to the COVID-19 outbreak. Current efforts to strengthen hospital preparedness should prioritize challenges related to surge capacity, critical care for COVID-19 patients, and staff welfare and protection.

Tuberculosis (TB) is a serious disease of public health concern, mainly in low- and middle-income countries. Most of these countries have challenges in diagnosis and treatment of TB in people with smear-negative pulmonary tuberculosis (SNPTB), which remains a significant public health challenge because of the global burden of the disease. We evaluated the epidemiology and clinical presentation of SNPTB in a cohort of patients with high HIV burden. The study was a cross-sectional study among patients with SNPTB in four major hospitals that care for TB/HIV patients in north-central Nigeria. All patients 18 years and above who were newly diagnosed as SNPTB, or patients with SNPTB who had not taken TB drugs for up to 2 weeks irrespective of their HIV status were recruited. Demographic data (sex, age), smoking status, and medical history (clinical form of TB, symptoms at admission, diagnostic methods, presence of comorbidities, prior TB treatment) were obtained using a semi-structured questionnaire. Detailed clinical examination was also done on all the study subjects. Baseline results of packed cell volume, HIV test and sputum acid fast bacilli done during TB screening were retrieved from the patients' case notes and recorded. Also, the base line Chest X-ray films taken during TB screening were reviewed and reported by two radiologists blinded to each other's reports. The Xpert MTB/RIF tests and sputum culture (using LJ medium) were done in a TB reference laboratory. A total of 150 patients with SNPTB were studied. Majority of the patients were female 93 (62%). The median age of the patients was 36.5 years with greater percentage of the patients within the ages of 25-44 years 92 (61.3%). Twenty-two (14.7%) of the patients had previous TB treatment. History of cigarette smoking was obtained in only 7(4.7%) of the patients while 82 (64.1%) were HIV positive. All the patients had a history of cough for over a period of at least three weeks, while, 27 (18%) reported having hemoptysis. About 87 (58%) had fever and 110 (73.7%) had anemia, while weight loss and night sweat were reported in 98(65.3%) and 82 (54.7%) of the patients respectively. Chest x rays were reported as typical of TB in only 24 (16%) of the patients. Of the 150 sputa sample analyzed, 21/150 (14.0%) and 22/150 (14.7%) where Gene Xpert and sputum culture positive respectively. The sensitivity and specificity of Gene Xpert assay were 81.8% (18/22; 95% CI 61.5 to 92.7%) and 97.4% (112/115; 95% CI 92.6 to 99.1%), respectively. The study found cough, fever and anemia to be the commonest presentation in patient with SNPTB in a high HIV burden patient's population. There is also relatively high culture positivity among the patients. This underscores the need to expand the facilities for culture and confirmation in TB centers across the country.

Background Hepatitis B virus (HBV) infection is highly endemic in Nigeria. The primary objective of this study is to describe the knowledge, self-reported vaccination status, and intention of healthcare workers to receive hepatitis B vaccine at a tertiary referral center in conflict-ravaged northeastern Nigeria. Methods This was cross-sectional analytical study among medical practitioners, nurses, laboratory workers, health attendants, pharmacists, and radiographers working at Federal Medical Center Nguru, Yobe State. Written informed consent was obtained from all study participants. Data were obtained using questionnaires and entered into a Microsoft Excel spreadsheet, cleaned and analyzed using JMP Pro software. Results Of the 182 participants, we found that 151 (82.97%), 81 (44.51%), 85 (46.70%), and 33 (18.13%) had good knowledge of HBV, good knowledge of hepatitis B vaccine, were vaccinated against HBV by the least dose, and had a complete hepatitis B vaccination status, respectively. The lack of availability of the vaccine was the main reason for not receiving the vaccine among the unvaccinated 36/91 (39.56%), followed by not knowing where to access the vaccine 19/91 (20.88%). Conclusion The study highlights the need for strategies to ensure the availability of hepatitis B vaccine in conflict settings and need for vaccinology training given the suboptimal level of awareness and uptake of the hepatitis B vaccine among the healthcare workers.

Objective: Hospital-acquired infections (HAI) are a global problem and a major public health concern in hospitals throughout the world. Quantification of HAI is needed in developing countries; hence we describe the results of a 2-year surveillance data in a tertiary hospital in Nigeria. Methodology: This study is a 2-year review using secondary data collected at a tertiary referral center in northwestern Nigeria. The data was collected using surveillance forms modeled based on the Centre for Disease Control (CDC) protocol. Descriptive statistics were used to present results as frequencies and percentages. Result: 518 patients developed HAI out of 8216 patients giving an overall prevalence of 6.3%. The mean age of the patients was 35.98 years (±15.92). Males constituted 281 (54.2%). UTI 223 (43.1%) was the most prevalent HAI. Overall, E. coli 207 (40.0%) was the most frequent isolates followed by P. aerugenosa 80 (15.4%). There was a high prevalence of cloxacillin resistant S. aureus (67.9%) and gram-negative rods resistant to third-generation cephalosporins. Trimethoprim-sulfamethoxazole resistance across the board was more than 90%. Conclusion: There is a high burden of HAI especially UTI in our hospital with resistance to commonly used antibiotics documented.