For effective Public Health measures, factors that influence Knowledge, Attitudes and Practices (KAP) need to be understood. In this paper, we document the relationship between levels of education on the KAP towards COVID-19 among the population of Edo State, Nigeria. A cross-sectional KAP questionnaire was delivered across 13 communities. The study population was dichotomized into those who had or had not completed secondary education. Chi-square tests were conducted to determine statistical significance. Of the 538 participants, 30% had completed secondary education. Those with secondary education were significantly more likely to recognize symptoms of COVID-19 (P<0.001). For attitudes, only one option showed a statistically significant association with 78.4% of those who did not complete secondary education having a high confidence in the church compared with 66% of those who had (P=0.022). For practices, those who have completed secondary education practiced all of the supplied measures more than those who had not, except for taking herbal supplements. Higher levels of education impacts on knowledge and practices but has less impact on attitudes regarding how well certain individuals/organizations can handle the pandemic. Findings highlighted the importance of tailoring public health communication and strategies to local populations to improve the efficacy.

ObjectivePoor sleep quality adversely affects the overall well-being and outcomes of patients with chronic kidney disease (CKD). However, it has not been well studied in Africans with CKD. We determined the prevalence of poor sleep quality and associated factors among patients with CKD.DesignThis was a cross-sectional study that involved patients with CKD .SettingsThe study was carried out in the outpatient clinic of nine hospitals in Nigeria.MethodsSleep quality, depressive and anxiety symptoms and quality of life (QoL) were assessed among 307 patients with CKD using Pittsburgh Sleep Quality Index Questionnaire, Hospital Anxiety Depression Scale Questionnaire and 12-item Short Form Health Survey Quality of Life Questionnaire, respectively. The prevalence of poor sleep quality and associated factors were determined. A p<0.05 was considered as statistically significant.ResultsThe mean age of the study participants was 51.40±15.17 years. The male:female ratio was 1.5:1 One hundred and twenty-one (39.4%) of the patients were on maintenance haemodialysis (MHD). The prevalence of poor sleep quality, anxiety symptoms and depressive symptoms among the patients was 50.2%, 37.8% and 17.6%, respectively. The prevalence of poor sleep quality in the CKD stages 3, 4, 5 and 5D was 38.1%, 42.6%, 52.2% and 58.7%, respectively. The prevalence of poor sleep quality was significantly higher in MHD patients compared with predialysis CKD (59.5% vs 43.6%; p=0.008). Factors associated with poor sleep quality were CKD stage (p=0.035), anaemia (p=0.003), pruritus (p=0.045), anxiety symptoms (p≤0.001), depressive symptoms (p≤0.001) and reduced QoL (p≤0.001). On multivariate analysis, factors associated with poor sleep were anxiety (AOR 2.19; 95% CI 1.27 to 3.79; p=0.005), anaemia (AOR 5.49; 95% CI 1.43 to 21.00;p=0.013) and reduced physical component of QoL (AOR 4.11; 95% CI 1.61 to 10.47; p=0.003).ConclusionPoor sleep quality is common among patients with CKD especially in the advanced stage. The significant factors associated with poor sleep quality were QoL, anaemia and anxiety symptoms. These factors should be adequately managed to improve the overall outcomes of patients with CKD.

BackgroundLassa fever (LF) is a viral haemorrhagic fever responsible of 5000 deaths per year in West Africa, with in-hospital mortality at 12%. Ribavirin is the only treatment available with worrying toxicity, questionable efficacy and low access because of its high cost. Consequently, there is an urgent need for new drugs to treat LF patients. MethodsThe INTEGRATE study is a platform, multinational, multicentre, sequential, seamless phase II-III, controlled, randomised, superiority trial in open-label parallel arms. Its primary objective is to compare the efficacy of each Investigational Medical Product (IMP) to Standard of Care Drug (SCD) to prevent death or organ failure in hospitalized patients with confirmed LF. The primary endpoint is the proportion of patients presenting no clinical aggravation between D0 and D14. All hospitalized patients, including pregnant women, are eligible for enrolment. The total follow-up period is 28 days. Three interim analyses are planned, with a total study population of 218 patients per arm. A co-sponsorship will be assumed by ANRS-MIE and the Irrua Specialist Teaching Hospital (ISTH).ResultsTrial inclusions will begin in Nigeria in April 2024 at the Federal Medical Centre Owo and at ISTH. Other West African sites (Liberia, Benin, Guinea and Nigeria) will join the platform as they complete a site preparedness program currently undergoing. The first IMP to be evaluated will be the repurposed drug Favipiravir, compared to the SCD Ribavirin. The second IMP will probably be the antiviral ARN 75039, which has shown promising results in pre-clinical phases and is currently in phase I evaluation. ConclusionThe ribavirin treatment for LF is still debated in term of safety, efficacy and affordability. The INTEGRATE study will provide evidence on new drugs efficacy in order to treat patients and reduce the burden of LF. Funding: Acknowledgment to EDCTP for funding this study.

BackgroundLassa fever (LF) is a severe re-emerging infectious disease caused by the Lassa virus (LV). LF is a priority disease on the World Health Organization’s R&D blueprint and affects a large number of countries in West Africa, with Nigeria carrying the highest case burden in the world. Current treatment options are limited to supportive care and the antiviral drug ribavirin. However, evidence for the efficacy of ribavirin in LF is poor. A recent study showed that in vivo plasma concentrations do not suffice to exert a relevant antiviral effect. New drugs for LF treatment are therefore urgently needed but no therapeutic trials have been conducted for this indication in the past decades. Favipiravir is a broad-spectrum antiviral registered for pandemic influenza that has also been clinically evaluated for other viral infections. It shows potent activity against LV in pre-clinical studies. To evaluate the safety and tolerability of favipiravir as repurposed drug in the treatment of LF, a phase II clinical trial was conducted. MethodsLF patients were recruited at the Irrua Specialist Teaching Hospital and the Federal Medical Centre of Owo in Nigeria, which are the worldwide largest LF treatment centres. Blood sampling for virological, serological and immunological analyses, hematology and biochemistry as well as clinical assessments were done on days 1, 2, and then every other day until the end of the study.ResultsIn total, 40 LF patients were included in the trial between 2021 and 2022. Results on cure rates, safety and tolerability of this first GCP compliant phase II clinical trial will be presented to provide first insights into this new treatment option for LF.

BackgroundMpox, previously known as monkeypox, -is an orthopoxvirus infection of the skin and previously a public health emergency of international concern. It reemerged in Nigeria over 5 years ago and has since spread to other parts of the world. This is a case report of a confirmed patient who was managed at Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria before the global surge. This report shows peculiar differences from previous patients managed at the same center in terms of the relatively prolonged eruptive phase, possible seasonal occurrence of mpox in the community, and some traditional care for mpox and skin rashes. It also corroborates previous reports of possible sexual transmission of mpox in Nigeria before the report from the global outbreak.Case presentationThe patient is a 30-year-old Nigerian male artisan with a 2-month history of raised rashes on the body that started on the genitals then involved other parts of the body. There was history of sore throat and unprotected sex with a female partner with similar rash whose other sexual history could not be ascertained. There was also history of “seasonal” rash in his village for about 7 years prior to his symptoms. Examination showed multiple vesicles and some nodules (ulcerating, healing, and healed) on the face, trunk, limbs, gluteal region, scrotum, palms, and sole, an almost circumferential penile ulcer, and lymphadenopathy. Polymerase chain reaction skin samples sent for mpox returned positive, while retroviral and coronavirus disease 2019 screenings were negative. He was managed in isolation while contact tracing in the affected community was initiated.ConclusionAtypical presentations of mpox, as managed in Irrua before the global surge, emphasize the varied spectrum of presentations (typical and atypical) in Nigeria. Therefore, there is a need for a higher index of suspicion for the uncommon presentations which will strengthen case recognition, case management, and community-based interventions as well as surveillance in the prevention and control of mpox in Irrua, its environs, Nigeria, and the world.

Mental health disorders among adolescents is on the rise globally. Patients seldom present to mental health physicians, for fear of stigmatization, and due to the dearth of mental health physicians. They are mostly picked during consultations with Family Physicians. This study seeks to identify the common mental health disorders seen by family Physicians in Family Medicine Clinics in Nigeria and Ghana. A descriptive cross-sectional study involving 302 Physicians practicing in Family Medicine Clinics in Nigeria and Ghana, who were randomly selected for the study. Data were collected using self-administered semi-structured questionnaire, and were entered into excel spreadsheet before analysing with IBM-SPSS version 22. Descriptive statistics using frequencies and percentages was used to describe variables. Of the 302 Physicians recruited for the study, only 233 completed the study, in which 168 (72.1%) practiced in Nigeria and 65 (27.9%) in Ghana. They were mostly in urban communities (77.3%) and tertiary health facilities (65.2%). Over 90% of Family Medicine practitioners attended to adolescents with mental health issues with over 70% of them seeing at least 2 adolescents with mental health issues every year. The burden of mental health disorder was 16% and the common mental health disorders seen were depression (59.2%), Bipolar Affective Disorder (55.8%), Epilepsy (51.9%) and Substance Abuse Disorder (44.2%). Family Physicians in Nigeria and Ghana attend to a good number of adolescents with mental health disorders in their clinics. There is the need for Family Physicians to have specialized training and retraining to be able to recognize and treat adolescent mental health disorders. This will help to reduce stigmatization and improve the management of the disease thus, reducing the burden.

Lassa fever (LF) is a potentially lethal viral haemorrhagic infection of humans caused by Lassa mammarenavirus (LASV). It is an important endemic zoonotic disease in West Africa with growing evidence for increasing frequency and sizes of outbreaks. Phylogeographic and molecular epidemiology methods have projected expansion of the Lassa fever endemic zone in the context of future global change. The Natal multimammate mouse (Mastomys natalensis) is the predominant LASV reservoir, with few studies investigating the role of other animal species. To explore host sequencing biases, all LASV nucleotide sequences and associated metadata available on GenBank (n = 2,298) were retrieved. Most data originated from Nigeria (54%), Guinea (20%) and Sierra Leone (14%). Data from non-human hosts (n = 703) were limited and only 69 sequences encompassed complete genes. We found a strong positive correlation between the number of confirmed human cases and sequences at the country level (r = 0.93 (95% Confidence Interval = 0.71–0.98), p &lt; 0.001) but no correlation exists between confirmed cases and the number of available rodent sequences (r = -0.019 (95% C.I. -0.71–0.69), p = 0.96). Spatial modelling of sequencing effort highlighted current biases in locations of available sequences, with increased sequencing effort observed in Southern Guinea and Southern Nigeria. Phylogenetic analyses showed geographic clustering of LASV lineages, suggestive of isolated events of human-to-rodent transmission and the emergence of currently circulating strains of LASV from the year 1498 in Nigeria. Overall, the current study highlights significant geographic limitations in LASV surveillance, particularly, in non-human hosts. Further investigation of the non-human reservoir of LASV, alongside expanded surveillance, are required for precise characterisation of the emergence and dispersal of LASV. Accurate surveillance of LASV circulation in non-human hosts is vital to guide early detection and initiation of public health interventions for future Lassa fever outbreaks.

Introduction: Traditional bullying (face to face bullying, that occurs within or around the school premises) among secondary school students is a persistent global public health problem; with varying long lasting mental, physical and academic consequences, not only on the victims but also the bullies and bystanders. It is a common phenomenon that is not limited to physical harm and manifests in many forms such as, verbal, or relational aggression, social exclusion and cyber victims of bullying. Bullying is commonly embedded in power imbalances and can be a call for help from the bullies. Development of an efficient prevention and intervention strategy requires understanding of the causes (family issues, low self esteem or lack of positive role models) of traditional bullying. This study therefore, aimed to determine the prevalence and pattern oftraditional bullying among secondaryschool students in Yenagoa Local Government, Bayelsa State Nigeria, which would aid development and implementation of appropriate antibullying policies. Methods: Adescriptive cross-sectional study was conducted from September 2021to December 2021. Selection of the 1,108 students aged between 10-21years was done by a two-stage sampling technique. The 46-item Bully Survey questionnaire adapted in 2003 by Swearer et al was utilized for data collection. Quantitative data was summarised using descriptive statistics.Test of association was done using Chi-square and Fisher’s exact tests andbinomial logistic regression analysis was also done to examine associations between variables, withp-value of &lt;0.05  considered significant. Results: Prevalence rates of 40.3%, 81.3%, and 86.3% were foundfor bullying perpetration, victimization and bystander respectively. Verbal bullying such as hauling of insults was the most common form of bullying behaviourperpetrated (64.8%); with sexual bullying being the least type observed (20%). Both bullying perpetration (46.9%) and victimization (88.3%) were significantly more common among female participants, while being a bullying bystander (99.4%) was commoner among male participants.Participants from junior classes were twice as more likely to perpetrate bullying(odds ratio[OR]:2.053, confidence interval[CI]:0.896-4.705). Also, those in schools with no anti-bullying policies were 1.26times more likely to be perpetrators of bullying ([OR] 1.269; CI: 0.229-7.031). School Class (p = 0.030) and absence of anti-bullying policy (p = 0.004) were significantly associated with bullying perpetration in the studied schools. Conclusion: The prevalence of traditional bullying among secondary school students in Yenagoa was very high. Wetherefore recommended that school authorities and the government should formulate appropriate school anti-bullying policies and implement same in order to curb the menace while shielding the weak groups from being victims of bullying in school.