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Objective: Maggot debridement therapy (MDT) is an emerging procedure involving the application of sterile maggots of the Dipteran species (commonly Lucilia sericata) to effect debridement, disinfection and promote healing in wounds not responding to antimicrobial therapy. Data on MDT in sub-Saharan Africa (including Nigeria) are scarce. This study aimed to use medicinal grade maggots as a complementary method to debride hard-to-heal necrotic ulcers and thereby promote wound healing. Method: In this descriptive study, we reported on the first group of patients who had MDT at Aminu Kano Teaching Hospital (AKTH), a tertiary hospital in northern Nigeria. The first instar larvae of Lucilia sericata were applied using the confinement (free-range) maggot therapy dressing method under aseptic conditions. Results: Diabetic foot ulcer (DFU) grade III–IV constituted more than half of the wounds (53.3%), followed by necrotising fasciitis (30%), and post-traumatic wound infection (10%). Others (6.7%, included pyomyositis, surgical site infection and post traumatic wound infection). The median surface area of the wounds was 56cm 2 . Of the 30 patients, half (50%) had two MDT cycles with a median time of four days. Of the wounds, 22 (73%) were completely debrided using maggots alone while eight (27%) achieved complete debridement together with surgical debridement. Wound culture pre-MDT yielded bacterial growth for all the patients and Staphylococcus aureus was the predominant isolate in 17 wounds (56.7%) while Pseudomonas aeruginosa and Streptococcus pyogenes were predominant in five wounds (16.7%) each. Only four (13.3%) wound cultures yielded bacterial growth after MDT, all Staphylococcus aureus. Conclusion: A good prognosis was achieved post-MDT for various wounds. MDT effectively debrides and significantly disinfects wounds involving different anatomical sites, thus enhancing wound healing and recovery. MDT is recommended in such wounds.

Background: In line with global standards and progress made in Prevention of Motherto- Child Transmission (PMTCT), an assessment of the outcome of Early Infant Diagnosis in northern Nigeria is necessary to evaluate progress towards zero Human immunodeficiency Virus (HIV) infection among children. Objectives: This study assessed the infection rate and risk factors for mother-to-child HIV transmission among HIV-exposed children in Kano, northwest Nigeria. Method: Using a retrospective cohort design, pregnant HIV-positive women and their exposed infants were recruited over a period of six years (2010 to 2016). Participants were enrolled during pregnancy or at delivery in the PMTCT clinic of a tertiary health facility in Kano, Nigeria. The main outcomes for the study were Early infant diagnosis positivity for HIV at 6 weeks and risk factors for positivity. Results: Of the 1,514 infants studied, early infant diagnosis was positive for HIV among 13 infants (0.86%). Infants whose mothers did not have antiretroviral therapy (adjusted Prevalence Ratio aPR = 2.58, 95%CI (1.85- 3.57)), who had mixed feeding (aPR = 12.06, 95%CI (9.86- 14.70)), and those not on antiretroviral prophylaxis (aPR = 20.39, 95%CI (16.04- 25.71)) were more likely to be infected with HIV. HIV-exposed infants on nevirapine and zidovudine prophylaxis were 95% and 74%, respectively, less likely to be infected with HIV. Conclusion: HIV infection rate remains high among HIV-exposed infants whose mothers did not receive PMTCT services. Scaling up proven interventions of early commencement of antiretroviral treatment for mothers, adherence to antiretroviral prophylaxis, and avoidance of mixed feeding among HIV-exposed infants would protect future generations from HIV infection.

There is a dearth of literature on vaccine hesitancy in Africa. In this study, we aimed to explore the drivers of hesitancy toward recommended childhood vaccines in Kenya, Malawi, and Ethiopia.A scoping review methodology was used as this evidence synthesis approach is suitable for mapping existing literature and identifying knowledge gaps. For this study, we systematically searched four electronic databases for published and unpublished literature from the three African countries. The methodological framework that was used is in line with Arksey and O'Malley's recommendations as modified by Levac.A total of 23 publications met the inclusion criteria and were included in the study. Majority of the studies were published after 2012. In these three African countries, hesitancy toward recommended childhood vaccines is driven by a mix of caregiver-related factors, health systems-related factors as well as the influence of community context.This study demonstrated that vaccine hesitancy in Kenya, Malawi, and Ethiopia is a complex phenomenon that is driven by multiple interrelated and interconnected factors.

BACKGROUND: Population-level health and mortality data are crucial for evidence-informed policy but scarce in Nigeria. To fill this gap, we undertook a comprehensive assessment of the burden of disease in Nigeria and compared outcomes to other west African countries. METHODS: In this systematic analysis, using data and results of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019, we analysed patterns of mortality, years of life lost (YLLs), years lived with disability (YLDs), life expectancy, healthy life expectancy (HALE), and health system coverage for Nigeria and 15 other west African countries by gender in 1998 and 2019. Estimates of all-age and age-standardised disability-adjusted life-years for 369 diseases and injuries and 87 risk factors are presented for Nigeria. Health expenditure per person and gross domestic product were extracted from the World Bank repository. FINDINGS: Between 1998 and 2019, life expectancy and HALE increased in Nigeria by 18% to 64·3 years (95% uncertainty interval [UI] 62·2-66·6), mortality reduced for all age groups for both male and female individuals, and health expenditure per person increased from the 11th to third highest in west Africa by 2018 (US$18·6 in 2001 to $83·75 in 2018). Nonetheless, relative outcomes remained poor; Nigeria ranked sixth in west Africa for age-standardised mortality, seventh for HALE, tenth for YLLs, 12th for health system coverage, and 14th for YLDs in 2019. Malaria (5176·3 YLLs per 100 000 people, 95% UI 2464·0-9591·1) and neonatal disorders (4818·8 YLLs per 100 000, 3865·9-6064·2) were the leading causes of YLLs in Nigeria in 2019. Nigeria had the fourth-highest under-five mortality rate for male individuals (2491·8 deaths per 100 000, 95% UI 1986·1-3140·1) and female individuals (2117·7 deaths per 100 000, 1756·7-2569·1), but among the lowest mortality for men older than 55 years. There was evidence of a growing non-communicable disease burden facing older Nigerians. INTERPRETATION: Health outcomes remain poor in Nigeria despite higher expenditure since 2001. Better outcomes in countries with equivalent or lower health expenditure suggest health system strengthening and targeted intervention to address unsafe water sources, poor sanitation, malnutrition, and exposure to air pollution could substantially improve population health. FUNDING: The Bill & Melinda Gates Foundation.

Background: Malaria is a major public health problem and life threatening parasitic vector-borne disease. For the first time, we established and report the molecular mechanism responsible for Anopheles gambiae s.l. resistance to pyrethroids and DDT from Yamaltu Deba, Southern Guinea Savanna, Northern-Nigeria. Methods: The susceptibility profile of An. gambiae s.l. to four insecticides (DDT 4%, bendiocarb 0.1%, malathion 5% and deltamethrin 0.05%) using 2–3 days old females from larvae collected from study area between August and November, 2018 was first established. Genomic DNA was then extracted from 318 mosquitoes using Livak DNA extraction protocol for specie identification and kdr genotyping. The mosquitoes were identified to species level and then 96 genotyped for L1014F and L1014S kdr target site mutations. Results: The mosquitoes were all resistant to DDT, bendiocarb and deltamethrin but fully susceptible to malathion. An. coluzzii was found to be the dominant sibling species (97.8%) followed by An. arabiensis (1.9%) and An. gambiae s.s (0.3%). The frequency of the L1014F kdr mutation was relatively higher (83.3%) than the L1014S (39%) in the threespecies studied. The L1014F showed a genotypic frequency of 75% resistance (RR), 17% heterozygous (RS) and 8% susceptible (SS) with an allelic frequency of 87% RR and 13% SS while the L1014S showed a genotypic frequency of RR (16%), RS (38%) and SS (46%) with an allelic frequency of 40% RR and 60% SS, respectively. Conclusion: This study reveals that both kdr mutations present simultaneously in Northern-Nigeria, however contribution of L1014F which is common in West Africa was more than twice of L1014S mutation found in East Africa.

Patent and proprietary medicine vendors (PPMVs) increase access to antibiotics through non-prescription sales in their drug retail outlets. This fosters irrational antibiotic use among people, thus contributing to the growing burden of resistance. Although training programmes on antibiotic use and resistance exist, they have disproportionately targeted health workers in hospital settings. It’s unclear if there is a relationship between such trainings and non-prescription sales of antibiotics among PPMVs which are more embedded in communities. Therefore, a cross-sectional study was conducted to elicit the determinants of non-prescription antibiotic sales among PPMVs in Kano metropolis, Nigeria. Through brainstorming, causal loop diagrams (CLDs) were used to illustrate the dynamics of factors that are responsible for non-prescription antibiotic sales. Multilevel logistic regression model was used to determine the relationship between training on antibiotic use and resistance and non-prescription antibiotic sales, after controlling for potential confounders. We found that two-third (66.70%) of the PPMVs reported that they have sold non-prescribed antibiotics. A total of three CLDs were constructed to illustrate the complex dynamics of the factors that are related to non-prescription antibiotic sales. After controlling for all factors, PPMVs who reported that they had never received any training on antibiotic use and resistance were twice as more likely to sell antibiotic without prescription compared with those who reported that they have ever received such training (OR = 2.07, 95% CI: 1.27–3.37). This finding suggests that there is an association between training on antibiotic use and resistance and non-prescription sales of antibiotics. However, the complex dynamics of the factors should not be ignored as it can have implications for the development of intervention programmes. Multifaceted and multicomponent intervention packages (incorporating trainings on antibiotic use and resistance) that account for the inherent complexity within the system are likely to be more effective for this setting.

Background:\ud Patent and proprietary medicine vendors (PPMVs) are widespread in communities and can potentially be used to expand access to routine immunization especially in underserved areas. In this study, we aimed to assess their readiness to implement routine immunization in Kano, Nigeria and identify factors associated with it.\ud \ud Methods:\ud We conducted a cross-sectional survey of PPMVs aged 18 years and above in Kano metropolis, Nigeria, using cluster sampling technique. A 10-item Likert scale-based measure was used to estimate readiness score. The relationship between selected factors and readiness score was examined using multilevel linear modeling technique.\ud \ud Results:\ud A total of 455 PPMVs with median age of 36 years participated in the study. The median raw score for readiness was 4.7 (IQR: 4.3 – 4-8) (maximum obtainable was 5). The mean readiness score (obtained through factor analysis) was 5.28 (SD: 0.58). Readiness score was associated with factors such as knowledge of immunization and task demand, engagement by other public health programs among others.\ud \ud Conclusion:\ud This study demonstrated the feasibility of measuring the level of readiness for implementing routine immunization among PPMVs. Given the high level of readiness, policy makers should consider the possibility of expanding access to immunization through PPMVs.

Background: Malaria is a major public health problem in Nigeria with 97% of its population with high morbidity and mortality. Mosquitoes play an important role in the transmission of malaria parasites. This study was conducted to eval­uate the current resistance status of Anopheles gambiae to insecticides. Methods: Larvae of An. gambiae was collected from three zones; A, B and C differentiated on the basis of variation in agricultural ecosystems between August and November, 2018 in the northeast and northwestern parts of Nigeria. They were carefully reared to adult stage and insecticidal susceptibility tests were conducted. Results: The mosquitoes tested showed high levels of resistance to all the insecticides used with the exception of mala­thion. Study zone A, recorded 74% mortality after 24h to deltamethrin compared to 81% from zone B and 82% from zone C, respectively. Mosquitoes from zone B exposed to DDT had the highest level of resistance at 37% compared to 40% and 53% from zones A and C, respec­tively. Resistant to bendiocarb was also observed, with zone A having the lowest mortality of 44% com­pared to 48% from zone C and 55% from Zone B, respectively. According to the results of knockdown tests, mosquitoes from Zone A exposed to deltamethrin recorded the lowest knockdown across the study locations while zone B recorded the lowest knockdown for DDT. Conclusion: The results of the study provide an insight into the current status of An. gambiae to four major insecticides in northern Nigeria as guideline for mosquitocontrol.

Background: Malaria is a parasitic vector-borne disease endemic in the tropical and subtropical countries of the world. The aim of this study was to investigate the current activities of the detoxification enzymes in resistant and susceptible Anopheles gambiae s.l. in northern Nigeria. Methods: Anopheles larvae were collected from northeast and northwestern Nigeria between Aug and Nov 2018. Biochemical analyses was carried out on the mosquitoes exposed to various insecticides (deltamethrin, DDT, bendiocarb, malathion) to measure and compare the enzymatic activities of the major detoxification enzymes (P450, GSTs, Esterase). Results: High levels of resistance was observed; DDT 37%–53% (95%, CI: 29–61), bendiocarb 44%–55% (CI: 39–60) and deltamethrin 74%–82% (CI: 70–86). However, these mosquitoes were found to be susceptible to malathion 99%–100% (CI: 98–100). The P450 and GSTs enzymes were found to be elevated in the resistant mosquitoes exposed to deltamethrin (1.0240±0.1902); (1.3088±1.2478), DDT (1.7703±1.4528); (1.7462±0.9418) and bendiocarb (1.1814±0.0918); (1.4479±1.0083) compared to the Kisumu strain (0.764±0.4226); (0.6508±0.6542), (0.3875±0.3482); (0.4072±0.4916) and (0.6672±0.3949); (0.7126±0.7259) at P

Compliance with recommended hand hygiene among healthcare providers is important in the prevention of morbidity and mortality associated with hospitalacquired infections including drug resistant microorganisms. This study aimed to determine the reported knowledge and hand hygiene practices among healthcare workers in Specialist Hospitals in Kano, Nigeria. Descriptive cross-sectional study design was used to study 302 healthcare workers in the specialist hospitals in Kano. Data was collected using semi-structured self-administered questionnaire and analyzed at univariate, bivariate and multivariate levels using IBM SPSS version 22. The age of the respondents ranged from 18 to 59 years with a mean of 31.4±9 years. Up to onethird (36.1%) of the respondents had poor knowledge despite the reported hand hygiene practice of 78%. Use of Alcohol Based Hand Rub and soap and water constituted 26.7% and 15.7% respectively. There was statistically significant association between working in MMSH, working in Pediatrics wards, CHEW cadre, and attendance of hand hygiene training in the last 3 years and having good knowledge of hand hygiene. Hand hygiene training was found to improve hand hygiene knowledge [AOR=1.58, 95% CI= (1.01-2.5)] and practice [AOR=1.12 95%CI= (0.64-1.99)]. Reported knowledge of hand hygiene was poor but the practices were encouraging and associated with formal training of healthcare workers on hand hygiene. Therefore, Hospital management should ensure regular hand hygiene training and re-training among healthcare workers.

Background: Children with cerebral palsy (CP) suffer from multiple problems and potential disabilities. These range from musculoskeletal problems, mental retardation, epilepsy, ophthalmologic and hearing impairment among others. Consequences of hearing loss include problems with speech and language development. Early detection in this difficult-to-test population may prevent these consequences of hearing loss. An otoacoustic emission assessment is useful in this regard. This study assessed transient-evoked otoacoustic emissions (TEOAEs) in children with CP. Materials and Methods: The study population were children with CP who presented at the paediatric neurology clinic during the study period. An equal number of control population matched for age and sex were also recruited using simple random sampling. An interviewer-administered questionnaire was used to obtain relevant clinical information. All participants selected underwent a detailed ear, nose and throat examination and TEOAE testing. Results: There were 330 participants in this study, categorised into CP cases (165) and non-CP controls (165). The age range of the participants was 1–12 years, with a mean age of 4.44 ± 2.92 among CP patients and 4.47 ± 2.90 among the controls. The male-to-female ratio was 2:1. TEOAEs were 'failed' in 83.6% of the CP patients and in 28.5% of the controls. This study found a statistically significant difference in 'failed' TEOAE result between the CP patients and the controls (P = 0.0001). Conclusion: This study found a high prevalence of 'failed' TEOAEs in children with CP in Kano.

Good vision is an essential component of safe driving and it is one of the most important requirements for commercial drivers. Little is known about the visual acuity of commercial drivers and the perceived effect on driving in our setting. The study assessed the prevalence and pattern of visual impairment among commercial intercity vehicle drivers in Dutse, Jigawa State, Nigeria. A systematic sampling technique was used to select 172 commercial intercity vehicle drivers in four major motor parks in Dutse. All respondent were tested for distance visual acuity using Snellen’s tumbling E chart and categorised as normal (VA≥6/12) or vision impaired (VA

We aimed to determine the concordance between own and perceived partner fertility intentions and identify predictors of contraceptive use among couples receiving antiretroviral therapy in Kano, Nigeria.A structured, validated questionnaire was used to interview 399 married men and women receiving antiretroviral therapy. Adjusted odds ratios for predictors of contraceptive use were derived from multivariate logistic regression models.Most couples (68.9%) had concordant fertility intentions. Only 10.0% of couples had discordant fertility intentions. Among 232 couples (58.1%) at least one partner used contraception. Male condoms were used by 45.9% of couples (One in 10 couples had discordant fertility intentions. Contraceptive use was suboptimal and was predicted by age, education, income, length of marriage, number of children, duration of antiretroviral therapy, partner's serostatus, sexual activity, fertility intention, spousal communication and the contraceptive decision-maker. Our findings highlight the need for spousal communication, joint contraceptive decision making and the integration of reproductive health services with antiretroviral therapy services.

Highlights • One of the routine health services that is at high risk of being disrupted by coronavirus disease 2019 (COVID-19) in Africa is childhood immunization. • Experiences from previous outbreaks on the continent indicates that any disruption of immunization services can result in epidemics of childhood vaccine-preventable diseases which will invariably increase child mortality. • Contextualized strategies are needed to mitigate the impact of COVID-19 on access and utilization of immunization services. • Using systems thinking can advance the understanding of the interaction between COVID-19 and immunization by explicitly elucidating the non-linear and dynamic relationships that exist between all elements of the system. • Implementation science models can be used to fast-track the use of evidence-based innovations to re-design local systems such that it enhances access and utilization of immunization services despite COVID-19 outbreak., One of the routine health services that is being disrupted by coronavirus disease 2019 (COVID-19) in Africa is childhood immunization. This is because the immunization system relies on functioning health facilities and stable communities to be effective. Its disruption increases the risk of epidemics of vaccine-preventable diseases which can increase child mortality. Therefore, policymakers must quickly identify robust and context-specific strategies to rapidly scale-up routine immunization in order to mitigate the impact of COVID-19 on their national immunization performance. To achieve this, we propose a paradigm shift towards systems thinking and use of implementation science in immunization decision making. Systems thinking can inform a more nuanced and holistic understanding of the interrelationship that between COVID-19, its control strategies and childhood immunization. Tools like causal loop diagrams can be used to explicitly illustrate the systems structure by identifying the feedback loops. Once mapped and leverage points for interventions have been identified, implementation science can be used to guide the rapid uptake and utilization of multifaceted evidence-based innovations in complex practice settings. As Africa re-strategize for the post-2020 era, these emerging fields can contribute significantly in accelerating progress towards universal access to vaccines for all children on the continent despite COVID-19.

Background: Malaria is a major public health problem in Nigeria with 97% of its population with high morbidity and mortality. Mosquitoes play an important role in the transmission of malaria parasites. This study was conducted to evaluate the current resistance status of Anopheles gambiae to insecticides. Methods: Larvae of An. gambiae was collected from three zones; A, B and C differentiated on the basis of variation in agricultural ecosystems between August and November, 2018 in the northeast and northwestern parts of Nigeria. They were carefully reared to adult stage and insecticidal susceptibility tests were conducted. Results: The mosquitoes tested showed high levels of resistance to all the insecticides used with the exception of malathion. Study zone A, recorded 74% mortality after 24h to deltamethrin compared to 81% from zone B and 82% from zone C, respectively. Mosquitoes from zone B exposed to DDT had the highest level of resistance at 37% compared to 40% and 53% from zones A and C, respectively. Resistant to bendiocarb was also observed, with zone A having the lowest mortality of 44% compared to 48% from zone C and 55% from Zone B, respectively. According to the results of knockdown tests, mosquitoes from Zone A exposed to deltamethrin recorded the lowest knockdown across the study locations while zone B recorded the lowest knockdown for DDT. Conclusion: The results of the study provide an insight into the current status of An. gambiae to four major insecticides in northern Nigeria as guideline for mosquitocontrol.

Heads of government in Africa responded to the COVID-19 pandemic by setting up high-level task forces at continental and national levels to coordinate preparedness and response strategies, in a bid to mitigate the spread of this virus on the continent. However, the current strategy at both continental and national levels are narrowly focused on COVID-19 and this is not sustainable. This is because Africa has a high burden of communicable and non-communicable diseases and sustaining access to essential life-saving health services is also critical during this pandemic. Therefore, we call for a more holistic health systems-based model for COVID-19 outbreak response. We recommend that response strategies should be transitioned from vertical isolated programmes to a broad-based "time-bound" integrated health system intervention that links with existing health programmes as well as other government and non-governmental sectors.

Rhesus isoimmunization present significant medico-social problems among rhesus negative women that could be prevented by adopting correct management practices by healthcare providers. This study assessed the predictors of knowledge and management practices of rhesus negative pregnant women among Primary healthcare workers in Kano Metropolis. A descriptive crosssectional study was used to study 424 respondents selected using multistage sampling technique with a response rate of 94%. Data was collected using self-administered semi-structured questionnaire and analyzed with IBM SPSS for Windows, Version 22. Majority of the respondents 354 (88.9) were greater than 24 years of age with mean age of 32.8±7.1. More than onehalf 235 (59.0%) of the respondents were female with Hausa speaking respondents by tribe constituting the majority 322 (80.9) healthcare workers studied. Almost twothirds (62.3%) of the respondents had good knowledge. However, only 24 (6.0%) employed correct management practice of rhesus negative pregnancy. Senior staff studied were 60% more likely {AOR=0.6, 95% CI (0.3-0.9)} to have good knowledge of rhesus negative pregnancy with those in service for 5 or more years to had 2.8 increased likelihood AOR=2.8, 95%CI (1.7-4.7)} of having good knowledge of Rhesus negative pregnancy. Healthcare workers requesting for blood grouping during ANC services provision were found to have up to 5.2 increased likelihood {AOR=5.2, 95% CI (2.7-10)} of having good knowledge of managing rhesus negative pregnancy. Senior staff were found to be 37% more likely to correctly practice the recommended management of Rhesus negative pregnant women {AOR=0.37 , 95%CI= (0.2-0.9)}. Most healthcare workers had good knowledge of rhesus negative pregnancy but wrong management practices. Government should ensure improved practice by putting in place favorable policies that will ensure training and compliance with recommended guideline for managing rhesus negative pregnant women.

Abattoir work is associated with significant public health hazards that result in occupational related diseases or aggravate the existing ill-health of non-occupational origin. This study assessed knowledge of occupational hazard, safety and hygienic practices among butchers in Kano Metropolis. Descriptive cross-sectional study design was used to study 321respondents in Kano metropolis. Data was collected using semi-structured interviewer administered questionnaire and analyzed at univariate, bivariate and multivariate levels using IBM SPSS version 22. The mean age of the respondents was 37.7±10.5 years. More than a third (35.8%) of the respondents were between the age ranges of 30 to 39 years. Overall, more than three-quarters 241 (75%) of the respondents had good knowledge of occupational hazard, cut/injuries was known by most of the respondents 309 (96.3%), while getting secondary infections from sustained wound and contracting diseases from infected animals were known by 241 (75.1%) and 211 (65.7%) of the respondents respectively. There was statistically significant association between knowledge of occupational hazard and having at least primary education (P=0.003), being in meat business for between 6 to 10 years (P=0.048) and selflearning of meat business (0.005). Respondents with formal education were 24% more likely to have good knowledge of occupational hazard [AOR=1.24, 95% CI (1.02-1.50)]. Being in meat business for at least 6 years was associated with 95% increase in knowledge of occupational hazard [AOR=0.95, 95% CI (0.58-1.55)]. Self-learning of butchering was associated with 70% increased likelihood [AOR=0.7, 95% CI (0.39-1.11)] of having good knowledge. Butchers selling meat in the restaurant were 7 times more likely to observe safety practices [AOR=6.9, 95% CI (2.24-21.01)]. This study revealed a good knowledge of occupational hazard among the butchers which is influenced by having formal education, duration in, and self-learning of the business, but safety practice was fair. Therefore, underscores the importance of formal training and supervision of butchers by relevant stakeholders to promote safety and hygienic practices. Government should therefore ensure regular training and supervision of butchers to promote safety and hygienic practice in order to prevent diseases.

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

BACKGROUND: Poor compliance with recommended hand hygiene practise by health-care workers is an emerging public health threat associated with significant morbidity, mortality and spread of multidrug-resistant microorganisms. OBJECTIVE: This study assessed the effect of voice reminder on compliance with recommended hand hygiene practise among the baseline, and post-intervention compliance with recommended hand hygiene among health-care workers using the WHO checklist for observation of 5-moments of hand hygiene of health-care workers in Kano. METHODS: Quasi-experimental study design was used. A total of 408 (204 in each arm) baseline and post-intervention observations were conducted in two hospitals in Kano, selected using a multistage sampling technique. Voice reminders were installed in the intervention hospital, and post-intervention observation was conducted 3 months after introducing a voice reminder. SPSS version 22.0 was used for data analysis. Relationship between variables was tested using χ2 and McNemar's test within the groups at 0.05 α-level of significance. RESULTS: Baseline compliance with hand hygiene in the intervention and control hospitals were 31.4% and 48.0%, respectively. Post-intervention compliance in the intervention and control hospitals were found to be 78.0% and 65.2%, respectively. Voice reminder improved compliance with hand hygiene practise when compared with baseline by +148% (P# = 0.3) in the intervention hospital compared with +36% (P# =0.1) in the control hospital. The differences were not statistically significant post-intervention when compared with the baseline. CONCLUSIONS: Voice reminder intervention improved hand hygiene compliance among health-care workers in the intervention hospital compared with the control hospital. Voice reminders should be provided in the hospitals by stakeholders. This can help in improving compliance with hand hygiene among health-care workers and reducing the burden of hospital-acquired infections due to the hands of health-care workers.

Background: Emergence of multidrug-resistant tuberculosis (MDR-TB) continues to threaten global tuberculosis (TB) treatment, care, and prevention, and it remains a major global health problem in many low- and middle-income countries with high morbidity and mortality. Objectives: The present study assessed MDR-TB treatment outcome and its predictors among adult patients in Kano, Nigeria. Methods: We conducted a secondary data analysis involving 283 adult patients treated for MDR-TB using routine data for MDR-TB programme in Kano State between August 2014 and September 2018. Results: The mean age (±standard deviation) of the respondents was 33.4 ± 11.6 years and up to 40% of them were within the age group of 25–34 years. About three-quarters of the participants 72.4% (205) were males; up to 63.6% (180) of the patients live in the urban areas, and mean duration of treatment initiation was 21 days after the diagnosis. Up to 66.8% (95% confidence interval [CI] = 61.1–72.4), patients had successful treatment, (cured) while 33.2% (95% CI = 27.6–38.9) died. After adjusting for confounding, gender and HIV status were found to be independent predictors of MDR-TB treatment outcome among MDR-TB patients in Kano. Male patients (adjusted odds ratio aOR = 0.38, 95% CI = 0.22–0.66, P = 0.001) and HIV-negative patients (aOR = 0.49, 95% CI = 0.28–0.87, P = 0.015) were less likely to die from MDR-TB. Conclusion: The study found a moderate treatment success rate for MDR-TB in Kano. Early initiation of treatment, control of HIV epidemic, and enhanced treatment supervision would likely improve treatment outcome.

Context: Despite convincing data on its efficacy and recommendation by the World Health Organisation that isoniazid preventive therapy (IPT) be included as part of the minimum package of care for people living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome, IPT has not been widely implemented. Aims: The study assessed uptake and predictors of IPT among HIV patients in Kano, Nigeria. Methods and Material: Using a cross-sectional study design, an interviewer-administered questionnaire was used to collect information from 320 HIV patients from 2 primary health-care centres using systematic sampling technique. Statistical analysis used: Data were analysed using SPSS version 20.0. Results: Majority of the respondents (309; 96.9%) believed that tuberculosis (TB) poses a threat to health and well-being of HIV patients and up to 307 (95.9%) knew that TB is preventable, but slightly over a half (172; 53.8%) of the respondents were using IPT for prevention of TB. Age, education, awareness and disclosure were found to be independent predictors of IPT uptake. Respondents who were 30 years or older (adjusted odds ratio [AOR] = 2.46, 95% confidence interval [CI] = 1.16–5.24) and those who disclosed their HIV status to partner/family (AOR = 1.52, 95% CI = 1.15–3.68) had higher odds of IPT uptake, whereas respondents with informal education (AOR = 0.46, 95% CI = 0.14–0.93) and those who lack awareness of IPT were less likely to uptake IPT (AOR = 0.23, 95% CI = 0.08–0.68). Conclusions: IPT is being underutilised for the prevention of TB among HIV patients in Kano. This implies the need for health-care workers to introduce strategies to improve counseling and disclosure.