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Vitalis C Okwor,1,2 Adeniyi F Fagbamigbe,1 Olufunmilayo I Fawole1 1Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria; 2Department of Radiation Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria Background: Head and neck cancer (HNC) is a major clinical and public health concern worldwide which impairs the vital functions of life. The treatment of metastatic HNCs is mainly palliative. This study examined the survival patterns and treatment outcomes in patients with HNCs in a tertiary hospital in Nigeria.Materials and methods: A review of the case files and treatment cards of patients with histological diagnosis of HNCs seen between January 2002 and December 2011 at the Radiotherapy Department, University College Hospital, Ibadan, was conducted. A total of 494 cases were identified, of which 481 had valid records. Analyses were done using Kaplan–Meier survival function and Cox proportional hazard regression techniques at 5% significance level.Results: The median age of patients was 42 years with a male-to-female ratio of 2:1. Most patients presented at stages 3 (50.7%) and 4 (36.8%). Nasopharyngeal carcinoma was the most common (42.6%) HNC, followed by paranasal sinus (17.7%) and laryngeal cancer (11.6%). The lung was the most common site of metastasis (25.5%). Patients who presented at stages 1 and 4 disease had a median survival of 7.8 years and 1.9 years, respectively. Patients treated with a combination of chemotherapy and radiotherapy had a median survival of 8.0 years compared with those who had a single modality of treatment (~6.3 years).Conclusion: Patient survival was inversely proportional to the stage of the disease. To encourage the early presentation of HNC cases, health education of the population on routine medical check-ups and on the symptoms suggestive of HNC is recommended. Health care providers should be trained to refer suspected cases promptly to tertiary health facilities for management. Keywords: head and neck cancer, treatment outcome, survivorship patterns

Olusola Olawoye,1 Olufunmilayo I Fawole,2 Christopher C Teng,3–5 Robert Ritch4,5 1Department of Ophthalmology, University College Hospital Ibadan, Nigeria and College of Medicine University of Ibadan, Ibadan, Nigeria; 2Department of Epidemiology, Medical Statistics and Environmental Health, College of Medicine, University of Ibadan, Nigeria; 3Department of Ophthalmology, New York University Langone Medical Center, New York, NY, USA; 4Einhorn Clinical Research Center, The New York Eye and Ear Infirmary, New York, NY, USA; 5New York Medical College, Valhalla, NY, USA Purpose: To evaluate the relevance of community eye outreach programs in the early detection of glaucoma patients in southwest Nigeria. Methods: This was a retrospective, cross-sectional study that was conducted among glaucoma patients referred to the eye clinic of the University College Hospital (UCH), Ibadan, Nigeria, between January 2009 and December 2010 from different sources, including community eye outreach programs. The source of referral, stage of glaucoma, and visual field were recorded. Results: Six hundred and fifty-three patients were studied during this period. The mean age was 56.3 years ± 16.6 years, with a median age of 60 years. Patients referred from eye outreach programs were more likely to have mild to moderate disease than patients referred from other sources, who were more likely to have severe disease according to both the optic nerve head assessment (P < 0.01, Pearson's Chi-square = 10.67, odds ratio = 1.7 [confidence interval = 1.23–2.31]) and visual field assessment (24-2) (P < 0.01, Pearson's Chi-square = 6.07, odds ratio = 1.5 [confidence interval = 1.08–2.03]). Conclusion: Community eye outreach programs appear highly useful in the earlier detection of glaucoma in sub-Saharan Africa. Keywords: community eye outreach, early glaucoma detection, Nigeria glaucoma detection, glaucoma awareness, sub-Saharan Africa.

Ifeoluwapo O Asekun-Olarinmoye,1 Esther O Asekun-Olarinmoye,2 A Fatiregun,3 Olufunmilayo I Fawole3 1Department of Public Health, School of Public and Allied Health, Babcock University, Ilishan-Remo, Ogun State, Nigeria; 2Department of Community Medicine, College of Health Sciences, Osun State University, Osogbo, Osun State, Nigeria; 3Department of Epidemiology, Medical Statistics, and Environmental Health, College of Medicine, University of Ibadan, Oyo State, Nigeria Introduction: The epidemic of human immunodeficiency virus (HIV) continues in Nigeria despite efforts to control it. Meaningful efforts aimed at combating this disease must be multisectoral. However, despite the major influence religious leaders have in this society, their role has not been well studied. The aim of the study was to assess the perceptions and activities of religious leaders on prevention of HIV/acquired immunodeficiency syndrome (AIDS) and care of people living with the virus in Ibadan, Nigeria. Materials and methods: In a cross-sectional study, 336 leaders from eight religious denominations in Ibadan were surveyed utilizing a self-administered, semi-structured questionnaire. Respondents were selected by cluster sampling technique. Data was analyzed using the Statistical Package for Social Sciences software version 15. Results: The mean age of respondents was 37.9 (± 13.5) years. The majority (97.6%) were aware of the HIV/AIDS scourge, and most had good knowledge of routes of transmission and modes of prevention (85.7%). Attitudes to people living with HIV/AIDS were positive in 84.2% respondents, and many practiced preventive measures (94.9%). One hundred and ninety (56.5%) respondents had ever preached about HIV/AIDS transmission and treatment to their congregations, while 257 (76.5%) used their position as a medium of educating their congregation about the dangers of HIV/AIDS and how to prevent it. Further analysis showed that respondents who were Christians (P = 0.026), had ever been married (P = 0.004), and were males (P = 0.002) were more likely to have ever preached about health issues to their congregations (individual role). Conclusion: The study concluded that the religious leaders are well informed about HIV/AIDS and have adequate knowledge and positive attitudes towards people living with AIDS. However, they need encouragement and training to enable them to more effectively harness their position for HIV prevention and to control programs and activities among their congregation to thereby play a crucial role in the war against HIV/AIDS in Nigeria. Keywords: faith-based organizations, HIV/AIDS care, perception, prevention, religious leaders

Traditional healers play an important role in the provision of healthcare in many communities in Africa. This study aimed to improve home management of malaria in children by assessing the healer's knowledge and practice. A semi-structured questionnaire interview of 127 traditional healers selected by proportionate sampling technique from two rural and two urban local government areas (LGAs) of southwestern Nigeria was followed by a training program. Malaria ranked first (87%) among the illnesses managed by the healers. Diagnosis of fever was often (72%) based on client history, physical examination (24.4%), consulting oracles (18.9%), and interpretation of dreams (3.1%). Treatment of malaria was with boiled herbs ('agbo'; 72%), ground herbs ('agunmu'; 14%), and incisions and scarifications (3%). Forty-one (32.5%) healers had referred febrile children to a health facility. Younger healers and those who had at least a secondary education were more likely to refer patients (p < 0.05 in both cases). Thirty-six healers (28.4%) had previous formal training on management of fevers, most of whom were the younger (p < 0.05), educated healers (p > 0.05), with fewer years of practice (p > 0.05). Research into traditional herbs (48%), better acknowledgment by government (23.6%), and collaboration with other health sectors were suggestions to improve practice. Traditional healers, especially the older, less-educated, and long-practicing healers, urgently require formal training and collaboration with other healthcare providers to improve knowledge and promote early referral of children with fever. [ABSTRACT FROM AUTHOR]

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., (© 2024. The Author(s).)

The African Union and the Africa Centers for Disease Control and Prevention issued a Call to Action in 2022 for Africa's New Public Health Order that underscored the need for increased capacity in the public health workforce. Additional domestic and global investments in public health workforce development are central to achieving the aspirations of Agenda 2063 of the African Union, which aims to build and accelerate the implementation of continental frameworks for equitable, people-centred growth and development. Recognising the crucial role of higher education and research, we assessed the capabilities of public health doctoral training in schools and programmes of public health in Africa across three conceptual components: instructional, institutional, and external. Six inter-related and actionable recommendations were derived to advance doctoral training, research, and practice capacity within and between universities. These can be achieved through equitable partnerships between universities, research centres, and national, regional, and global public health institutions., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

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., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Ndejjo, Chen, Kabwama, Bamgboye, Bosonkie, Bassoum, Kiwanuka, Salawu, Egbende, Sougou, Afolabi, Leye, Bello, Adebowale, Dairo, Seck, Fawole, Mapatano MA, Tsai and Wanyenze.)

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., (© 2024. The Author(s).)

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., (© 2024. The Author(s).)

Background: African 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)., Methods: The 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., Results: The 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., Conclusion: Although 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., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Bosonkie, Egbende, Namale, Fawole, Seck, Kizito, Kaba, Kiwanuka, Diallo, Bello, Kabwama, Kashiya, Monje, Dairo, Bondo, Namuhani, Leye, Adebowale, Bassoum, Bamgboye, Fall, Salawu, Afolabi, Ndejjo, Wanyenze and Mapatano.)

Introduction: The SARS-CoV-2 (COVID-19) pandemic overwhelmed some primary health care (PHC) systems, while others adapted and recovered. In Nigeria, large, within-state variations existed in the ability to maintain PHC service volumes. Identifying characteristics of high-performing local government areas (LGAs) can improve understanding of subnational health systems resilience., Methods: Employing a sequential explanatory mixed-methods design, we quantitatively identified 'positive deviant' LGAs based on their speed of recovery of outpatient and antenatal care services to prepandemic levels using service volume data from Nigeria's health management information system and matched them to comparators with similar baseline characteristics and slower recoveries. 70 semistructured interviews were conducted with LGA officials, facility officers and community leaders in sampled LGAs to analyse comparisons based on Kruk's resilience framework., Results: A total of 57 LGAs were identified as positive deviants out of 490 eligible LGAs that experienced a temporary decrease in PHC-level outpatient and antenatal care service volumes. Positive deviants had an average of 8.6% higher outpatient service volume than expected, and comparators had 27.1% lower outpatient volume than expected after the initial disruption to services. Informants in 12 positive deviants described health systems that were more integrated, aware and self-regulating than comparator LGAs. Positive deviants were more likely to employ demand-side adaptations, whereas comparators primarily focused on supply-side adaptations. Barriers included long-standing financing and PHC workforce gaps., Conclusion: Sufficient flexible financing, adequate PHC staffing and local leadership enabled health systems to recover service volumes during COVID-19. Resilient PHC requires simultaneous attention to bottom-up and top-down capabilities connected by strong leadership., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

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., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Ndejjo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

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<0.01). North-East (PC=-43.3; 95% CI: -51.7 to -34.9) and South-West (PC=-18.3; 95% CI: -25.2 to -11.5), respectively, had the highest and the least decline in SBA utilisation. Overall, ANC and SBA patterns of change were relatively similar across the north-south divide though the change effect was considerably pronounced in the north., Conclusion: There was a substantial reduction in ANC and SBA utilisation due to the COVID-19 pandemic in Nigeria, especially in the northern regions. Targeted and contextually relevant interventions should be implemented to alleviate the impact of emergency response on access to EHS and promote access to care during the pandemic., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)

This review's main objective is to discuss how demographic and epidemiological transitions relate to the burden of adolescent healthcare in sub-Saharan Africa (SSA). The review explicitly discussed the burden of adolescent healthcare, the current African policies on adolescent healthcare, and gaps in the African policies compared with Europe and North America. We also examined how adolescent healthcare policies evolve and documented the recommended essential part of the policy for enhancing its sustainability. The burden of adolescent health is high in SSA with diseases and reproductive health-related problems prevailing among adolescents. However, variations exist in the burden of adolescent healthcare across countries in the region. While some SSA countries are currently undergoing demographic and epidemiological transition processes concerning adolescent health care, the majority are either at an early stage of the transition or yet to commence the process. Policy-makers should consider effective ways to improve adolescents' health in SSA through preventive mechanisms and a multi-dimensional approach.

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., (© 2023. The Author(s).)

This study determined the past-year prevalence of physical, sexual and psychological intimate partner violence (IPV) and associated factors among young women in urban slums and non-slums of Ibadan, Nigeria.A cross-sectional study, using a multistage cluster sampling method was used to select 1050 ever-partnered young women aged between 18 and 24 years from the five Local Government Areas (LGAs) in Ibadan municipal. All localities were classified into slums and non-slums using the UN-Habitat 2003 criterion. Independent variables were respondents' and partners' characteristics. Dependent variables were physical, sexual and psychological IPV. Data were analysed using descriptive statistics and binary logistic regression model (α0.05).Prevalence of physical (31.4%, 13.4%), sexual (37.1%, 18.3%), and psychological IPV (58.6%, 31.5%) were significantly higher in the slum than non-slum communities. Multivariate analysis showed that secondary education (aOR:0.45, 95%CI: 0.21 - 0.92) reduced IPV experience while being unmarried (aOR:2.83, 95%CI: 1.28 - 6.26), partner's alcohol use (aOR:1.97, 95%CI: 1.22 - 3.18), and partner's relationship with other women (aOR:1.79, 95%CI: 1.10 -2.91) increased IPV experience in slum communities. In non-slum communities, having children (aOR:2.99, 95%CI: 1.05-8.51), non-consensual sexual debut (aOR: 1.88, 95%CI: 1.07-3.31) and witness of abuse in childhood (aOR:1.82: 95%CI: 1.01 - 3.28) increased experience of IPV. Acceptance of IPV and partner's witness of abuse in childhood increased experience of IPV in both settings.This study confirms that IPV is common among young women in Ibadan, Nigeria, but higher among women in slum communities. Findings also showed different factors associated with IPV in slum and non-slum communities. Therefore, targeted interventions for each urban stratum are recommended., (© 2023. The Author(s).)

Introduction: As part of efforts to rapidly identify and care for individuals with COVID-19, trace and quarantine contacts, and monitor disease trends over time, most African countries implemented interventions to strengthen their existing disease surveillance systems. This research describes the strengths, weaknesses and lessons learnt from the COVID-19 surveillance strategies implemented in four African countries to inform the enhancement of surveillance systems for future epidemics on the continent., Methods: The four countries namely the Democratic Republic of Congo (DRC), Nigeria, Senegal, and Uganda, were selected based on their variability in COVID-19 response and representation of Francophone and Anglophone countries. A mixed-methods observational study was conducted including desk review and key informant interviews, to document best practices, gaps, and innovations in surveillance at the national, sub-national, health facilities, and community levels, and these learnings were synthesized across the countries., Results: Surveillance approaches across countries included - case investigation, contact tracing, community-based, laboratory-based sentinel, serological, telephone hotlines, and genomic sequencing surveillance. As the COVID-19 pandemic progressed, the health systems moved from aggressive testing and contact tracing to detect virus and triage individual contacts into quarantine and confirmed cases, isolation and clinical care. Surveillance, including case definitions, changed from contact tracing of all contacts of confirmed cases to only symptomatic contacts and travelers. All countries reported inadequate staffing, staff capacity gaps and lack of full integration of data sources. All four countries under study improved data management and surveillance capacity by training health workers and increasing resources for laboratories, but the disease burden was under-detected. Decentralizing surveillance to enable swifter implementation of targeted public health measures at the subnational level was a challenge. There were also gaps in genomic and postmortem surveillance including community level sero-prevalence studies, as well as digital technologies to provide more timely and accurate surveillance data., Conclusion: All the four countries demonstrated a prompt public health surveillance response and adopted similar approaches to surveillance with some adaptations as the pandemic progresses. There is need for investments to enhance surveillance approaches and systems including decentralizing surveillance to the subnational and community levels, strengthening capabilities for genomic surveillance and use of digital technologies, among others. Investing in health worker capacity, ensuring data quality and availability and improving ability to transmit surveillance data between and across multiple levels of the health care system is also critical. Countries need to take immediate action in strengthening their surveillance systems to better prepare for the next major disease outbreak and pandemic., (© 2023. The Author(s).)

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 12 th 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 1 st (January-March) and 3 rd (July-September) quarters of the year in Nigeria and Senegal, and in the 2 nd (April-June) and 3 rd (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., (© 2023. The Author(s).)

Purpose: The aim of this study was to explore the perceptions of male civil servants in Ibadan, Nigeria about the perpetration of IPV and to document their suggested measures to prevent IPV in our communities in Nigeria., Methods: Four focus group discussions were conducted among 36 male civil servants selected from Oyo State Secretariat, Ibadan using purposive sampling technique. Data were transcribed and analysed using thematic approach., Results: Six major themes were identified; awareness of the forms of IPV, women and men as victims, causes, attitude, consequences as well as the suggested strategies for the prevention of IPV. Physical and psychological abuse were mentioned across the groups. The respondents pointed out that women experience IPV more than men, but that men also experience it. Some respondents stated that physical and psychological abuse against female intimate partners were acceptable in some circumstances according to the societal norms. The negative effects of IPV on physical, mental and social well-being of the individual, families and society were mentioned. Suggested ways of preventing IPV include tolerance and patience which will promote healthy, respectful and non-violent relationships among intimate partners., Conclusion: Considering the perceptions and attitudes of these men to IPV, it is important to reach out to both genders for appropriate preventive and educational intervention in ending IPV among women and men.

Paucity of data exists on the timing of puberty, particularly the pubarche, in developing countries, which has hitherto limited the knowledge of the timing of pubarche, and assistance offered by physicians to anxious young people in Nigeria. Factors associated with the timings of puberty and pubarche are not well documented in Nigeria. We hypothesized that the timing of pubarche in Nigeria differs by geographical regions and other characteristics. We assessed the timing of pubarche among adolescents and young adults in Nigeria and identified prognostic factors of the timing by obtaining information on youths' sexual and reproductive developments in a population survey among in-school and out-of-school youths aged 15 to 24 years in Nigeria. A total of 1174 boys and 1004 girls provided valid information on pubarche. Results of time-to-event analysis of the data showed that mean age at pubarche among males aged 15 to 19 years and 20 to 24 years was 13.5 (SD = 1.63 years) and 14.2 (SD = 2.18 years) (respectively) compared with 13.0 (SD = 1.57 years) and 13.5 (SD = 2.06 years) among females of the same age. Median time to pubarche was 14 (Interquartile range (IQR) = 3) years and 13 (IQR = 3) years among the males and females, respectively. Cumulatively, 37% of the males had attained pubarche by age 13 years versus 53% among females, 57% vs 72% at age 14, and 73% vs 81% at age 15. The likelihood of pubarche among males was delayed by 5% compared with females (Time Ratio (TR) = 1.05: 95% CI = 1.03-1.05). Every additional one-year in the ages of both males and females increases the risk of pubarche by 1%. Similar to the females, males residents in Northeast (aTR = 1.14, 95% CI: 1.07-1.21), in the Northwest (aTR = 1.20, 95% CI: 1.13-1.27) and in the Southwest (aTR = 1.18, 95% CI: 1.11-1.26) had delayed pubarche than males from the South East. Yoruba males had delayed pubarche than Ibo males (aTR = 1.06, 95% CI: 1.01-1.12). Age at pubarche among adolescents and young adults in Nigeria differed among males and females with earlier onset among females. Pubarche timing varied mainly by ethnicity, region, and location of residence. Our findings will aid medical practitioners in providing appropriate advice and support on pubarche-related issues among adolescents in Nigeria as it could help douse pubarche anxiousness in relation to request for medical assistance., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2022 Fagbamigbe et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

This study explored the experience of economic vulnerability and its effect on girls' future aspirations, relationships, and financial reliance on male partners, as well as risk for intimate partner violence (IPV) and related health consequences. Thirteen Focus Group Discussions (FGDs) were conducted among 122 female adolescents aged 15-19 years. Participants reported that lack of economic resources limits girls' ability to be economically independent by reducing opportunities to receive education or enter into a trade. Economic vulnerability decreases girls' ability to become economically independent, increasing financial reliance on male partners, and in turn, increasing risk for IPV, sexually transmitted infections, and unintended pregnancy.

Although community screening and testing have been recommended by the World Health Organization, the extent of readiness and the associated factors among rural populations remain unknown. We investigated the factors associated with perception of the COVID-19 transmission risk and readiness for testing in rural areas of Southwest Nigeria. Using a multistage cluster sampling technique, cross-sectional data was collected from 922 adults aged 18 years and above who were resident in rural communities selected across three States in the Southwest region between June and August 2020. Descriptive statistics and binary logit models with robust standard errors were utilized for analysis. Mean age of respondents was 37.0 (SD = 15.8) years; 58.6% female; 46.5% had secondary education; and most were traders (33.2%) and artisans (29.9%). Only 149 respondents (16.2%) had a accurate perception of COVID-19 transmission risk. Adjusted logit models showed that independent factors associated with accurate perception of COVID-19 transmission risk include: age 18&19 years (OR = 0.50, CI: 0.34-0.73); exposure to electronic media (OR = 1.84, CI: 1.07-3.18); and being an in-migrant (OR = 3.38, CI: 2.44-4.68). Less than one-third (28.8%) were willing to test for COVID-19. Severe fear of COVID-19 (OR = 3.99, CI: 1.36-11.74) was associated with willingness to undergo COVID-19 testing. Socio-demographic predictors of testing readiness included: male sex (OR = 1.51, CI: 1.36-1.68); traditional religion (OR = 2.81, CI: 1.05-7.53); and exposure to electronic media (OR = 1.31, CI: 1.06-1.62). Awareness campaigns need to be scaled up to improve perception and preparedness to test for COVID-19., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Authors. Published by Elsevier B.V. on behalf of African Institute of Mathematical Sciences / Next Einstein Initiative.)

Intimate partner violence (IPV) is a form of Gender-based violence that is a public health problem. The health outcomes of IPV have cascading effects on the family's financial, emotional, sexual, and physical wellbeing. Sub-Saharan Africa carries a significant burden of IPV. In The Gambia, domestic is prevalent, with more than 80% of the women believing that it is justified for a man to beat his wife. Men are the predominant perpetrators of IPV in the Gambia. The study employed a cross-sectional design using a qualitative approach utilizing phenomenology focused on the participants lived experiences. The study was conducted in Basse in the Upper River Region in The Gambia. The study purposefully sampled 26 respondents, all of whom were married. Semi-Structured in-depth interviews were administered to the respondents in Mandinka, Wolof and Serahuli to collect the study data. Both deductive and inductive approaches were used to develop the codebook and themes relevant to the study data. The participants expressed various ideas regarding IPV, with the general perspectives suggesting the causes, effects, and ultimate probable solutions to the phenomenon. The respondents interviewed believed that both women and men bared the responsibility of IPV. Varying connotations were placed on the individual's responsibility towards perpetrating IPV with men seen as physically and financially violent compared to women. Solutions to the IPV problem were seen as both external and internal, with government intervention being offered up as a solution. The overall response in the study indicated that there was a general understanding of IPV and a need to educate both men and women of its dangers to the overall health. The finding of this study shows that further needed on a large scale to understand the dynamics of IPV in The Gambia. This will help in designing sustainable solutions to the IPV problem.

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., (© 2022. The Author(s).)

The mode of training and work of the military personnel is different from that of civil servants and may affect their relationships with their intimate partners. This study assessed and compared the prevalence and correlates of self-reported Intimate Partner Violence (IPV) perpetration against female partners by male military personnel and civil servants in Ibadan, south-western Nigeria. A cross sectional survey of 1240 respondents, comprising 631 military personnel and 609 civilians, was conducted using a multistage sampling technique. A self-administered questionnaire was used to collect data on the respondents' characteristics and the different types of IPV perpetrated by them. Chi square test was used to compare the proportions of the different types of IPV perpetration and logistic regression analysis was used to determine the predictors of IPV perpetration in the two study groups. Military personnel reported significantly more IPV such as physical abuse, psychological abuse and controlling behaviors than the civil servants. Childhood exposure to inter-parental IPV and history of physical fight with another woman significantly increased the odds of perpetration of each type and any form of IPV in the two populations after controlling for other variables. Military personnel were significantly more likely to perpetrate any form of IPV than the civil servants. IPV was prevalent in both groups but was more among the military personnel. There is a need for multidisciplinary interventions such as psycho-education and conflict management skills to address violence against female intimate partners especially among the military population in Nigeria., Competing Interests: Conflict of Interest None.

Background: Military personnel are one of the high risk groups recognized as perpetrators of intimate partner violence (IPV). Little is known about IPV experience of partners of naval personnel. This study determined the prevalence and correlates of IPV experience among partners of naval personnel., Methods: A cross-sectional survey of 435 male and female partners of naval personnel selected using the multistage sampling technique from the Navy Barracks in Lagos, Nigeria was conducted. Data were collected using a 40 item interviewer-administered questionnaire between August and September 2017. Univariate, bivariate and multivariate analysis was done to identify the predictors of partners' experience of IPV. Analysis was done at p-value ≤0.05., Results: The mean age of the respondents was 32.7 ± 7.86yrs and 72% were females. The lifetime prevalence of any IPV experience was 40.7% (with 74.4% of this experienced by females, CI: 0.81-1.91). The prevalence of controlling behaviour, psychological, sexual, economic and physical IPV were 31.5%, 16.3% 12.4%, 12.0% and 8.5% respectively. There was a positive association between experience of IPV and respondents' occupational status (p < 0.0001), lifetime experience of physical (p < 0.0001), sexual abuse (<0.0001), and history of childhood abuse (p < 0.0001). After adjustment for confounders, age (AOR = 2.11, CI = 1.07-4.16), occupational status (AOR = 4.56, CI = 2.30-9.02), history of childhood abuse (AOR = 2.10, CI = 1.26-3.49,) and partners' alcohol use (AOR = 3.41, CI = 1.38-8.39) remained significant factors influencing experience of IPV., Conclusion: The prevalence of IPV experience among partners of naval personnel was high. Being unemployed, experience of abuse in childhood and having a partner who consumed alcohol increased partners' vulnerability to IPV. Naval personnel would benefit from marital counseling and training on non-violence conflict resolution strategies.

We investigated 13 domestic violence (DV) and sexual assault agency directors' perspectives regarding Nigerian immigrants' experiences of violence, DV-related service needs, and best strategies for providing those needs. Directors across five U.S. states were surveyed. Descriptive analyses showed the most common DV types were controlling behavior and cultural/traditional. The most important DV support needs were informational, informal, and legal. Formal support from DV agencies, support groups, and law enforcement was rated the most helpful strategies. Participants wanted to learn more about Nigerian immigrants' DV experiences. Findings highlight implications for the development of Nigerian-specific DV services.

Background: Intimate partner violence (IPV) refers to any behavior by either a current or ex-intimate partner or would-be rejected lover that causes physical, sexual, or psychological harm. It is the most common form of violence in women's lives. According to a World Health Organization report, about 1 in 3 women worldwide experience at least one form of IPV from an intimate partner at some point in her life. In the Gambia, about 62% of pregnant women experience at least one form of violence from an intimate partner. IPV has severe physical and mental health consequences on a woman ranging from minor bodily injury to death. It also increases the risk of low birth weight, premature delivery, and neonatal death., Methods: A health facility-based cross-sectional study design was carried out to assess the magnitude and factors associated with intimate partner violence among pregnant women seeking antenatal care in the rural Gambia. The study enrolled 373 pregnant women, and a multi-stage sampling technique was used to select the respondents. An interviewer-administered structured questionnaire was used to obtain information from the study participants. The collected data were analyzed using SPSS Ver.22. Bivariate and multivariate logistic regression were used to determine the association between dependent and independent variables. Odds ratio with 95% confidence interval (CI) was computed to determine the presence and strength of associated factors with IPV., Result: The study reveals that the prevalence of IPV in The Gambia is 67%, with psychological violence (43%) being the most common form of IPV reported by the respondents. The multivariate logistic regression result reveals that being aged 35 years or older [AOR 5.1(95% CI 1.5-17.8)], the experience of parents quarreling during childhood [AOR 1.7(95% CI 1.0-2.75)], and having cigarette smoking partners [AOR 2.3 (95% CI 1.10-4.6)] were significantly associated with IPV during pregnancy., Conclusion: This study has demonstrated that all forms of IPV in rural Gambia are frequent. Women older than 35 years, had experienced parents quarreling, had a partner who smoked, and a partner who fight with others were more likely report IPV compared to other pregnant women in the study. We recommend that IPV screening should be included as an integral part of routine antenatal care services in The Gambia. Community-based interventions that include indigenous leaders, religious leaders, and other key stakeholders are crucial to create awareness on all forms of IPV and address the risk factors found to influence the occurrence of IPV in rural Gambia., Competing Interests: The authors have declared that no competing interests exist.

Introduction: intestinal parasitic infection has been reported as a cause of morbidity and mortality among HIV patients on antiretroviral therapy (ART) due to interruption in treatment of the defaulting HIV patients. This study aimed to determine the prevalence and possible causes of intestinal parasites among HIV patients on ART., Methods: a survey involving 375 adult HIV/AIDS patients selected using a systematic random sampling technique was conducted in a Jos University Teaching hospital, Plateau State, Nigeria. Socio-demographic and clinical data was collected using semi-structured interviewer administered questionnaire and electronic dataset review. Fresh stool samples were collected from all participants for laboratory identification of intestinal parasites using formol-ether sedimentation and modified Ziehl-Neelsen techniques. Descriptive statistics, odds ratio and logistic regression model were computed at P ≤ 0.05., Results: the mean age of the study participants was 41.6±9.3years. Majority 294 (78.4%) were females, 141 (37.6%) lived in the rural area, 50 (13.3%) respondents did not have toilets in their homes. Most 275 (73.3%) had ART adherence level of 95% and above. Prevalence of intestinal parasites was 28.5%. Females (aOR = 2.14, 95% CI=1.12 - 3.89) and participants with no toilet facilities (aOR = 2.0, 95% CI=1.03 - 3.94) were significantly more likely to have intestinal parasites., Conclusion: the prevalence of intestinal parasites was high among HIV patients. Gender and unavailability of toilet in homes were found to be predictors of having parasites. We recommend that HIV patients should be periodically screened for IPs during the follow-up clinic visits., Competing Interests: The authors declare no competing interests., (Copyright: Olawunmi Toyin Ajayi et al.)

Introduction: neglected tropical diseases (NTDs) are serious public health problem worldwide. Primary healthcare (PHC) workers are important in the prevention and control of these diseases. Accurate diagnosis and timely reporting are essential for effective public health response. The study assessed the knowledge of PHC workers on NTDs and identified factors influencing its recognition and reporting., Methods: the study was a hospital based cross-sectional survey. A multistage sampling technique was used to select 327 healthcare workers from sixty-six PHC facilities in Ibadan, Oyo State, Nigeria. A semi-structured, self-administered questionnaire was used to elicit information on respondent´s socio-demographic characteristics, knowledge, recognition and reporting of NTDs. Data analysis were done using independent sample t-test, analysis of variance and logistic regression with p-value set at 0.05., Results: one hundred and eighty seven (57.2%) respondents had good knowledge of NTDs. The NTDs most known were; Schistosomiasis (78%), Rabies (64.5%), and Onchocerciasis (57.2%). Urban healthcare workers had higher knowledge score on NTDs (p= 0.018). Young age (AOR= 3.40, CI= 1.20 -9.63), length of practice (AOR=4.65, CI= 1.20-18.09) and previous training on NTDs (AOR = 7.09, CI= 3.15 - 15.93) significantly predicted NTDs recognition, while availability of reporting forms (AOR= 3.17, CI=1.07 - 9.35), training on disease reporting (AOR= 3.41, CI= 11.17 - 9.92) and feedback on previous diseases reported (AOR= 4.12, CI= 1.32-12.80) were significant predictors of reporting NTDs., Conclusion: the healthcare workers knowledge on NTDs was inadequate. Periodic training and continued education on NTDs are recommended. PHC workers also require supportive supervision., Competing Interests: The authors declare no competing interests., (Copyright: Daniel Chukwuyere Emeto et al.)

Introduction: This study explored the motivations for and relationship dynamics that may promote girls' vulnerability for intimate partner violence and sources of support reported in unhealthy relationships among girls residing in low-income communities in Ibadan, Nigeria., Methods: Focus group discussions (n = 14; 122 girls) were conducted among girls aged 15-19 years, who reported having been in a relationship lasting at least 3 months. Girls were recruited from schools and worksites where partner violence has been reported in high proportions. Data were analysed using conceptual content analyses and independently coded by two researchers., Results: Adolescent girls reported keeping their relationships secret from their parents. While girls reported that sometimes relationships were out of love, relationships were also often motivated by girls' financial need. The financial and secretive nature of these relationships appeared to place girls at risk for intimate partner violence, with sexual coercion, resulting in multiple adverse social and health outcomes, including sexually transmitted infections and unintended pregnancy. Girls reported that leaving an abusive relationship is especially difficult when girls rely financially, were sexually involved, pregnant, or have had a child with the male partner. Friends/peers, rather than girls' family, were often the source of support for intimate partner violence., Conclusion: Early identification of unhealthy relationships and supporting girls to be financially independent appear to be critical to reduce vulnerability to violence. Peer-based interventions may be most appropriate, given that girls' friends, rather than parents, were most often the source of support for intimate partner violence and other relationship challenges., (Copyright © 2021 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.)

Background: Emergency situations, including epidemics, increase incidence of violence against women, especially intimate partner violence (IPV). This paper describes specific scenarios of IPV reported by women during the COVID-19 pandemic in Nigeria to provide insight for policy and programmatic efforts., Methods: This paper draws on seven de-identified case reports from organisations serving women experiencing IPV as well as media coverage of IPV cases in Nigeria, between April and May, 2020., Results: In most cases, reports identified IPV that was occurring prior to the lockdown, but increased in severity or involved new types of violence during the lockdown. The case scenarios included descriptions of many forms of IPV commonly reported, including physical, economic, psychological and sexual violence, often concurrently. Several women also reported threats of being thrown out of their homes by perpetrators, which threatens women's ability to protect themselves from exposure to COVID-19, but could also leave women stranded with no access to transportation, social services, or other resources during the lockdown. Several women also reported IPV that involved custody of children, as well as IPV that disrupted women's income generation. IPV was also reported in relation to economic stressors associated with the lockdown. Reports highlight how the lockdown disrupted women's social support, hindering accessibility of formal and informal sources of help., Conclusion: The lockdowns in Nigeria may have inadvertently placed women already experiencing partner violence at risk for experiencing more severe violence, new challenges to cope with violent experiences, and other forms of violence, including violence that used the lockdown as a way to threaten women's security and ability to protect themselves from the virus. Hence, there is need for innovative approaches to support victims, with emphasis on ways in which perpetrators of IPV may be using the threat of COVID-19 to further gain power and control over partners.

Background: Community eye outreach (CEO) screening is an important model which has been widely employed to detect eye conditions such as cataract and glaucoma in high-risk groups. There is a dearth of data on the eye care practices of glaucoma patients identified using this model in South West Nigeria., Objectives: The aim of this article is to assess the eye care practices, knowledge, and attitudes of glaucoma patients/suspects identified at CEO screenings in Nigeria., Design of the Study: This was a mixed method study with quantitative and qualitative approaches., Setting in Which the Study Took Place: The study was carried out at 24 outreach screening centres in communities in Oyo and Osun states., Materials and Methods: The quantitative component of this study was a cross-sectional survey of patients with suspected glaucoma identified at routine CEO in South West Nigeria. Surveys were administered by trained personnel and gathered information on knowledge and attitudes towards glaucoma. The qualitative component consisted of structured interviews with providers to assess their knowledge and perspectives of glaucoma patients' attitudes and behaviours., Results: A total of 1881 patients were screened at 24 outreach screenings in South West Nigeria, among which 120 glaucoma cases/suspects were identified. Fifty-six (46.7%) of the glaucoma patients were aware of glaucoma, but only 39 (32.5%) patients could answer at least one knowledge question correctly. Predictors of awareness of glaucoma were minimum of secondary school education [adjusted odds ratio (OR) 8.76; 95% confidence interval (CI) 3.18-24.13] and having had an eye check-up in the past (adjusted OR 5.87; 95% CI 1.92 - 17.92). Patients said cost and 'not knowing the disease was serious' were reasons for not following up at the main hospital. Health workers interviewed said that cost and poor knowledge were the main reasons glaucoma patients frequently attended free outreach screening events rather than seeking definitive care., Conclusion: Although CEO screenings improve access to eye care, provision of appropriate health education programs and strengthening of the health insurance scheme are needed to improve its impact in glaucoma care., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Journal of the West African College of Surgeons.)

Background: There has been a significant reduction of abortion rates in high-income countries, while the rates remain unchanged in low- and middle-income countries. In Ethiopia, for example, the number of women of reproductive age seeking an induced abortion is increasing. However, there is limited information concerning the reasons why the occurrence of this procedure is increasing. Thus, this study aimed to identify factors associated with having induced abortion in Addis Ababa, Ethiopia., Methods: An unmatched case-control study was conducted using a semi-structured, interviewer-administered questionnaire from October to December 2017. The cases were 147 women of reproductive age who underwent abortion in a health facility or presented with complications due to induced abortion conducted outside the health facility. The controls were 295 women who came for antenatal care and who reported never having had an induced abortion. The cases were selected by consecutive sampling from nine health facilities, whereas the controls were selected by systematic sampling from the same health facilities. Bivariate and multivariate logistic regression models were employed using STATA version 14 to identify factors associated with induced abortion., Results: The mean age of cases was 26.5 ± 5.7 years, while for the controls it was 28.1 ± 4.8 years. Being unmarried (AOR = 9.6; 95% CI: 1.5-61.7), having primary (AOR = 5.3; 95% CI: 1.5-18.3) and tertiary (AOR = 5.7; 95% CI: 1.6-21.1) education, earning monthly income 100-300 USD (AOR = 0.2; 95% CI: 0.1-0.4) and >  300 USD (AOR = 0.1; 95% CI: 0.0-0.2), initiating first intercourse between ages of 15 and 19 (AOR = 4.7; 95% CI: 1.4-15.6), marrying before the age of 18 (AOR = 2.9; 95% CI: 1.3-6.7), and having two children (AOR = 4.7; 95% CI: 1.8-12.7) were independent predictors of induced abortion., Conclusion: Family planning programs hoping to reduce the occurrence of induced abortion should specifically target unmarried women, low income, and those who have two children. The government should also work on preventing early marriage and providing sexual and reproductive health education to help adolescents delay age at first sexual experience.

Background and Aim: Bovine tuberculosis (bTB) is a zoonotic disease of major public health importance, especially in many developing countries, including Nigeria, where control measures are largely not applied, and the risks of human infection are high. This study was aimed at determining the current prevalence of bTB in slaughtered cattle and identifying factors associated with the risk of disease transmission among cattle handlers toward making informed control measures to limit human-animal interface disease transmission., Materials and Methods: Serum samples at slaughter and lesions suggestive of bTB collected during postmortem examination of 187 slaughtered cattle at the Oko-Oba Abattoir, Agege, Lagos State, Nigeria, were subjected to lateral flow and Ziehl-Neelsen (ZN) techniques, respectively. Furthermore, a structured questionnaire was interviewer-administered to 156 cattle handlers to investigate associated exposure factors to bTB infection. Data were analyzed using bivariate and multivariate logistic regression., Results: The prevalence of bTB in cattle was 25.7% and 7.0% by lateral flow technique and ZN, respectively. The seropositivity was highest in cattle with poor body condition (50.0%), then with good (36.4%) and fair (25.0%) body conditions. The questionnaire survey revealed that being in livestock handling business for >6 years (p=0.001), not knowing the mode of transmission (p=0.02) and ignoring TB lesions at slaughter (p=0.02) were exposure factors associated with increased risk of bTB infection among the cattle handlers. Further, multivariate analysis showed that those who spent more than 6 years in livestock handling were about 4 times (Adjusted odds ratio [AOR]=3.5; 95% confidence interval [CI]=1.1-7.6, p=0.01) more likely to be exposed to bTB infection than those with lesser years. Again, respondents who called the attention of meat inspectors on seeing lesions in animals were about 4 times less likely to be exposed to bTB infection than those who ignored it (AOR=0.3; CI=0.1-0.8, p=0.01)., Conclusion: This study has reiterated the endemicity of bTB in cattle population in Nigeria, with the prevalence of 25.7% and 7.0% of bTB by lateral flow and ZN techniques, respectively. This portends potential risk for disease transmission at the human-animal interface, particularly at the abattoir setting. The study also identified important knowledge and practice gaps which would enable informed, all-inclusive, and well-directed programs for effective control of the disease in both human and cattle populations., (Copyright: © Agbalaya, et al.)

Background: The Ibadan Low Back Pain Disability Questionnaire (ILBPDQ) was developed to meet the need for a LBP treatment outcome measure that was appropriate for the Nigerian culture and environment. The objective of this study was to determine the psychometric properties of ILBPDQ., Methods: This study used the validation design. One hundred and forty-two participants with LBP (LBPPs) and 142 age and sex-matched participants without LBP (NLBPPs) were included. The LBPPs were recruited consecutively from Physiotherapy clinics of selected tertiary hospitals in the six geopolitical zones of Nigeria. Both LBPPs and NLBPPs completed the ILBPDQ - the LBPPs completed the Numerical Pain Rating Scale (NPRS). The ILBPDQ was completed by 113 LBPPs two days after initial assessment. Sixty-four of the LBPPs received physiotherapy for 5-weeks, after which they were reassessed using ILBPDQ and NPRS., Results: ILBPDQ score of LBPPs was significantly higher than that of NLBPPs (construct validity) and LBPPs NPRS score correlated significantly with their ILBPDQ score (r = 0.50) at baseline and post intervention (r =0.35) (divergent validity). ILBPDQ scores at baseline and 48 hours later for LBPPs correlated significantly (Intra Class Correlation =0.80) (test re -test reliability). Cronbach's α for ILBPDQ was 0.84 (internal consistency). The postintervention ILBPDQ and NPRS scores for LBPPs were significantly lower than their pre-intervention ILBPDQ scores (responsiveness) and NPRS scores. The changes in ILBPDQ and NPRS scores of the LBPPs correlated significantly (r =0.62) (responsiveness)., Conclusion: The ILBPDQ demonstrated evidence of validity, reliability and responsiveness., Funding: University of Ibadan Senate Research Grant., Competing Interests: Conflict of interest: None declared, (Copyright © The Author(s).)