Center In Nigeria Research Articles

COVID-19 in Sub-Saharan Africa: A Multi-Institutional Survey of the Impact of the Global Pandemic on Cancer Care Resources

Purpose/Objective(s)The COVID-19 pandemic has direct and indirect impact on patients with cancer. Low- and middle-income regions, especially sub-Saharan Africa, are especially vulnerable to a negative impact on cancer resources and outcomes. We report the initial indirect impact of COVID-19 on cancer care in the sub-Saharan Africa region approximately 14 months into the pandemic.Materials/MethodsAt the start of the pandemic, we created a consortium of African and North American cancer centers and NGOs for the distribution of factual and timely information and data on COVID-19 and cancer care. A survey was distributed to consortium members and other colleagues from the sub-Saharan Africa region to understand the impact of COVID-19 in cancer care resources. Survey respondents represent cancer experts from 8 centers in Ghana, Nigeria, Kenya, Ethiopia, South Africa, Rwanda, and Zimbabwe.ResultsAll sites report SARS-COv-2 transmission amongst cancer patients and staff. A total of 48 staff developed COVID-19 infection with one site reporting a single death. Additionally, 62.5% of sites report loss of oncology physician or nursing staff due to redeployment for COVID-19 care resulting in minimal (20%), moderate (60%), or other (20%) impact on cancer care. All 8 sites report a government mandated lockdown with a median duration of 2.3 months (IQR .9-4.2 months). Impact of the lockdown on cancer care was reported as none (12.5%), minimal (12.5%), moderate (50%) and severe (25%). Additionally, we surveyed the impact of COVID-19 on resources in radiation, medical and surgical oncology services. A total of 25% of responders reported decreases in radiation resources while 37.5% reported changes in medical and surgical oncology resources. For radiation oncology, the most common impact was access to CT imaging for 3D-conformal planning (25%), access to brachytherapy (12.5%), and medical physics support (12.5%). For medical oncology, the most frequent impact was access to chemotherapy (37.5%) and blood products (12.5%), and loss of oncology ward space (12.5%). The most frequent impact for surgical oncology was access to operating rooms (37.5%), ventilators (12.5%), anesthesia (25%), blood products (25%), and other supply chain issues (25%). Of centers who reported impact on cancer care, severity of impact was none (50%) and moderate (50%) for radiation oncology; mild (25%) and moderate (75%) for medical oncology; and moderate (75%) and severe (25%) for surgical oncology.ConclusionOur survey identified diffuse impact of COVID-19 on all facets of cancer care across sub-Saharan Africa. Based on physician assessment of impact, the discipline of surgical oncology may be impacted the greatest. Additional studies measuring the impact of COVID-19 on cancer outcomes are ongoing.

Anatomic imaging study of luminal diameter of the circle of Willis in patients with ischemic stroke

Objectives: Stroke or cerebrovascular accident is associated with defects in the circle of Willis; the vascular network that supplies the brain. There is currently lack of literature on the involvement of the circle of Willis in patients with stroke or its association with impending stroke. The objective of the study was to evaluate luminal diameter of arteries that constitute the circle of Willis in patients with stroke using computed tomography angiography (CTA) and magnetic resonance imaging (MRI) scans. Material and Methods: Angiograms of 340 male and female patients aged 15–>75 (40.18 ± 1.1 and 43.68 ± 1.18) years with suspected stroke, referred for either brain CTA or MRI in selected hospitals/diagnostic centers in Nigeria were evaluated using RadiAnt and the MicroDicom viewer software applications. A retrospective descriptive research design was adopted with approval from the federal health research ethics committee. Direct measurement of luminal diameter of major arteries of the circle of Willis was done using SPSS version 25 at P < 0.05. Results: From the 340 images assessed, 256 (75.29%) patients had ischemic stroke with luminal diameter of arteries of the circle of Willis ranged from 1 mm to >3 mm while 84 (24.71%) patients were without stroke with luminal diameter ranged from 1 mm to 2.11 mm (P < 0.05). Conclusion: Patients with stroke have larger luminal diameter of arteries that form the circle of Willis when compared to patients without stroke. The study has established for the 1st time, luminal diameter of circle of Willis that may be an index in the sampled Nigerian population.

Pre and post flooding malaria parasitemia in gravid women, South East, Nigeria

The effect of global change on the incidence of vector borne diseases including malaria is of great importance. Malaria has been regarded as one of the most sensitive disease that responds fast to climate change. Pregnant women tend to have reduced immunity are more vulnerable to vector borne diseases such as malaria especially with climate change like flooding where these vectors borne diseases are endemic. To measure malaria parasitaemia in gravid women pre and post flooding and also to determine the relationship between malaria and seasonal flooding in South east Nigeria. This was a hospital-based cross-sectional study involving pregnant women aged 15- 45 years attending the antenatal clinics of two maternity centres in a rural community South east Nigeria. Malaria was determined using the thick and thick blood films. Plasmodium falciparum species was examined in this study. Chi-square was used to assess the relationship between malaria and seasonal flooding. One Hundred and fifty pregnant women were recruited for the study. The prevalence of malaria in the gravid women pre and post flooding were 60.00% and 65.30% respectively. Malaria parasite was highest in the gravid women aged 28-31 years and the primigravids. There was no statistical difference between malaria and parity. The mean parasite density in the gravid women was significantly higher post flooding than pre flooding with p-value of 0.001. There was no significant relationship between malaria parasite in gravid women and the periods of investigation. The prevalence of malaria parasite among gravid women in the study area is high regardless of the seasonal flooding. Hence, the need for adherence to malaria prophylaxis protocol by the health care professionals and increase on community health education on malaria preventive strategies.

Tuberculosis Treatment Outcomes and its Associated Factors in a Tertiary Health Center in Southwestern Nigeria

Background: Monitoring and evaluation of tuberculosis (TB) treatment outcome is an essential component of the evaluation of a country's TB control program. Nigeria's current TB treatment success rate of 86% is below the World Health Organization target of 90% by 2025. This study aims to evaluate TB treatment outcomes in a tertiary health center in southwestern Nigeria over a 5-year period and to document the factors associated with poor TB treatment outcomes. Materials and Methods: This was a retrospective study of all TB patients seen at the TB clinic of the hospital from January 1, 2015, to December 31, 2019. Data were extracted from the TB clinic register. Data extracted included sociodemographic factors, HIV status, treatment category, rifampicin resistance, extrapulmonary TB, and treatment outcome. Treatment outcome was categorized as successfully treated or poor treatment outcome (death, treatment failure, and lost to follow-up). Results: Five hundred and nine TB cases were analyzed with a mean (standard deviation) age of 40.2 (17.7) years. Treatment outcome was as follows: successfully treated – 426 (83.7%), died – 62 (12.2%), treatment failure – 14 (2.8%), and lost to follow-up – 7 (1.4%). Poor treatment outcome was associated with older age (P = 0.003), HIV-positive status (P = 0.044), and smear-negative TB (P = 0.047). Conclusion: The treatment success rate in our center is high but can be improved. More efforts should be put in place to ensure improved outcomes, particularly among the elderly and HIV-positive patients.

Building local capacity for emergency coordination: establishment of subnational Public Health Emergency Operations Centres in Nigeria

Public Health Emergency Operations Centres (PHEOCs) provide a platform for multisectoral coordination and collaboration, to enhance the efficiency of outbreak response activities and enable the control of disease outbreaks. Over...

Paving the Way for Entrenching the Diaspora’s Voting Rights under the Nigerian Laws: Legal Prospects, Challenges and Potential Solutions

Diaspora overseas or external voting hinges on citizen’s universal right to vote and has become popular among modern democracies all over the world. Over a hundred nations have so far adopted overseas or with varying scopes and/or restrictions. Currently, Nigerian laws do not provide for the right of Nigerians living overseas to participate in elections unless they personally present themselves for registration and voting at designated centers in Nigeria. Since 1999, calls have persisted among Nigerians in the diaspora for law reforms to enable them to exercise their universal right to vote during elections. Since then, various administrations in the Nigerian government have yielded to those calls by setting up an independent dedicated body that is saddled with the responsibility of engaging and mobilizing Nigerians living overseas as equal allies in national development. Nigerians in the diaspora, as equal citizens, should be allowed to exercise their right to vote just like their peers. This article reviews the 1999 Nigerian Constitution and the Electoral Act of 2010 and finds that there are some legal hurdles that have to be tackled to allow diaspora overseas voting, and proffers some constitutional amendments and other legal reforms that are necessary to bring this lofty concept into fruition.

An Empirical Analysis of the Impact of Government Health Expenditures on the Performance of the Health Sector in Nigeria

Purpose of the Study: The purpose of the study is to examine whether government health expenditures have an impact on the health sector performance in Nigeria for the period (1979-2019). Methodology: The study employs the expo facto research design. The annual time series data were sourced from World Development Indicators (WDI) and the Statistical Bulletin of the Central Bank of Nigeria (CBN) for several years. The dynamic ordinary least square (DOLS) estimation method is employed to measure the coefficient of the parameters to test the four hypotheses developed. Main Findings: The findings of the study indicate that capital health expenditure and recurrent health expenditures are positively related to the performance of the health sector proxy by life expectancy rate but statistically insignificant. However, capital health expenditure is statistically significant to life expectancy. Research Implication: It was recommended that priority need to be placed on government capital spending on health such as building and equipping of health centres in every community to enhance accessibility to health centres in Nigeria. The novelty of the study: There is a need for an adequate mechanism to be put in place by the health sector to check the stealing of public funds and punish those who misuse and divert such funds. This can promote the generation and prudent utilization of revenue to equip our various health centres ahead of eventualities like the COVID-19.

A mathematical study on a fractional COVID-19 transmission model within the framework of nonsingular and nonlocal kernel

In this work, a mathematical model consisting of a compartmentalized coupled nonlinear system of fractional order differential equations describing the transmission dynamics of COVID-19 is studied. The fractional derivative is taken in the Atangana-Baleanu-Caputo sense. The basic dynamic properties of the fractional model such as invariant region, existence of equilibrium points as well as basic reproduction number are briefly discussed. Qualitative results on the existence and uniqueness of solutions via a fixed point argument as well as stability of the model solutions in the sense of Ulam-Hyers are furnished. Furthermore, the model is fitted to the COVID-19 data circulated by Nigeria Centre for Disease Control and the two-step Adams-Bashforth method incorporating the noninteger order parameter is used to obtain an iterative scheme from which numerical results for the model can be generated. Numerical simulations for the proposed model using Adams-Bashforth iterative scheme are presented to describe the behaviors at distinct values of the fractional index parameter for of each of the system state variables. It was shown numerically that the value of fractional index parameter has a significant effect on the transmission behavior of the disease however, the infected population (the exposed, the asymptomatic infectious, the symptomatic infectious) shrinks with time when the basic reproduction number is less than one irrespective of the value of fractional index parameter.

A model for analysing the dynamics of the second wave of corona virus (COVID--19) in Nigeria

The resurgence of the coronavirus (COVID--19) disease is rapidly taking its toll on many nations across the globe. As the situation rapidly evolves, the entire world is faced with difficult and challenging moment and the need to be safe from the disease. Several international efforts are geared towards the production of effective vaccine for curing the disease. But, pending the availability of such vaccine, the need to flatten the curves is now the top priority of both governmental and non-governmental organisations in Nigeria. Estimation of the basic reproduction number of the disease is crucial to understanding its dynamics and making suitable preventive policies that will slow the spread and ultimately flatten the curves. In this work, we propose a compartmental--based model for analysing the dynamics of the pandemics' second wave in Nigeria taking into consideration, the current control measures. Using the Quasi--Newton algorithm, the model is fitted to the available data provided by Nigeria Centre for Disease Control (NCDC), World Health Organization (WHO) and accessible on the Wolfram Data Repository. The basic reproduction number of the second wave of the disease in Nigeria is estimated using the model. The model was also used to estimate the infection rate, average latent time, average recovery rate and average mortality rate of the disease. Efficiency of the current control measures is also measured. Forecast of the turning points and possible vanishing time of the virus in Nigeria are made. The infection rate, average latent time, average recovery rate and average mortality rate of the disease are estimated. Also, the basic reproduction number of the disease in Nigeria is estimated. Predictions on the turning points and possible vanishing time of the virus in Nigeria are made. Recommendations on how to manage the resurgence of the disease in Nigeria are also suggested.

"What Are You Really Doing in This Country?": Emigration Intentions of Nigerian Doctors and Their Policy Implications for Human Resource for Health Management.

The emigration of doctors from Nigeria has been on the increase in recent years, with no obvious efforts to manage or mitigate the negative impacts of this growing trend on the already weak health system. This study assessed the emigration intentions of doctors undergoing residency training at the premier tertiary healthcare center in Nigeria and the factors that influence these intentions. This mixed-method study was cross-sectional in design. A semi-structured questionnaire was used to identify the factors that influence the emigration intentions of resident doctors at the University College Hospital, Ibadan, Southwest Nigeria. In-depth interviews (IDIs) were also conducted to further explore the push and pull factors identified from the survey and their migration preferences. A total of 244 resident doctors completed the questionnaires and 10 participated in the IDIs. Overall, 57.4% of the respondents had emigration intentions and 34.8% had made various attempts at emigrating. Major factors that encouraged resident doctors to emigrate to developed countries included better working and living conditions, good salary and the opportunity for career advancement in destination countries. Family ties was the single most important factor that deterred resident doctors from emigrating. The UK was found to be the top preferred destination. Strategic approaches and multisectoral collaborations will be required to address doctors’ emigration from Nigeria. These efforts should be targeted at not just the health sector but should also include the social and economic aspects of the lives of resident doctors, to improve their living conditions.

Neonatal mortality: morbidity pattern and risk factors in a resource-limited centre in North Central Nigeria

The Journal is the primary organ of Continuing Paediatric Medical Education in Sri Lanka. The journal also has a website. Free full text access is available for all readers.The Sri Lanka Journal of Child Health is now indexed in SciVerse Scopus (Source Record ID 19900193609), Index Medicus for South-East Asia Region (IMSEAR), CABI (Centre for Agriculture and Bioscience International Global Health Database), DOAJ and is available in Google, as well as Google Scholar.The policies of the journal are modelled on the Committee on Publication Ethics (COPE) Guidelines on Principles of Transparency and Best Practice in Scholarly Publishing. Sri Lanka Journal of Child Health is recognised by the International Committee of Medical Journal Editors (ICMJE) as a publication following the ICMJE Recommendations.

Impact of COVID-19 on Ophthalmic Outpatient Services in An Eye Care Center in Southern Nigeria.

Coronavirus disease-2019 (COVID-19) is a communicable disease and a global pandemic affecting different parts of the world including Nigeria. Measures to curb the spread of the causative virus included a nationwide lockdown. The aim of this study was to assess the impact of COVID-19 on ophthalmic outpatient services in an eye care center in Nigeria. The medical statistics for all persons attending the Ophthalmic Outpatient Clinic from January to August 2020 and January to August 2019 was obtained. The statistics for January to August 2020 was compared with that of the corresponding months in 2019 for outpatient clinic attendance, gender, and number of children and adults. In the 2019 study period, the total number of patients attending the Ophthalmic Outpatient Clinic was 16,189. There were 6788 males, 9401 females, 2963 children, and 13,226 adults. In similar months in 2020, the total number of patients was 8,735, of which 3,934 were males, 4801 females, 1651 children, and 7084 adults. There was an overall decline of 46% in the number of outpatient attendance in 2020. The decline was 76.3% in April 2020 (peak of the lockdown). There was a rebound in outpatient visits in July 2020 (when the interstate travel ban was lifted) to 4.9 times that of April 2020; however, this was 56.9% that of July of the preceding year. COVID-19 pandemic impacted negatively on outpatient visits. A rebound in the number of visits was observed when the interstate travel ban was lifted, although far below the preceding year's value.

1170Investigation of COVID-19 outbreak in a South West State of Nigeria: Preliminary findings

1170Investigation of COVID-19 outbreak in a South West State of Nigeria: Preliminary findings

COVID-19 in Nigeria: account of epidemiological events, response, management, preventions and lessons learned.

After the World Health Organization declared COVID-19 a pandemic, a hand full of cases and deaths have been recorded globally, Nigeria inclusive. A retrospective analysis of the COVID-19 weekly disease update report by the Nigeria Centre for Disease Control (NCDC) covering February 29, 2020 (Week 9) and March 28, 2021 (Week 12) was adopted for this study. Data were curated from the NCDC database. As of March 28, 2021, Nigeria is the 5th most affected African country and the 77th most affected country globally with 162,593 COVID-19 cases and 2,048 COVID-19 related deaths. COVID-19 has been reported in all 36 States and the Federal Capital Territory. However, Lagos has remained the epicenter of the pandemic accounting for 35.4% of the pandemic in Nigeria while Kogi State is the least affected State (0.003%). The trend showed male predilection while the age bracket 35-39 years was the most affected. The attack rate was found to be 78.8 per 100,000 of the population while the cumulative death per 100,000 of the population was found to be 1.0. The case fatality rate was found to be 1.30. Approximately 1,778,105 COVID-19 tests have been performed while 923,623 doses of vaccine have been administered. COVID-19 has been reported in all states in Nigeria as well as the Federal Capital Territory with many of the cases involving males. The case trend showed a bimodal form indicating a second wave occurrence. Nigeria government has initiated some combative measures as well as vaccine initiation.

45Nigeria Centre for Disease Control Resident Doctors Internship Pilot: Translating Knowledge To Action In Epidemiology

45Nigeria Centre for Disease Control Resident Doctors Internship Pilot: Translating Knowledge To Action In Epidemiology

A Markov model of COVID-19 susceptibilities, infections, recoveries and fatalities: evidence from Nigeria

PurposeThe purpose of this study is to determine the proportion of the population that will be susceptible to the COVID-19 pandemic, as well as the proportions of infections, recoveries and fatalities from the COVID-19 pandemic.Design/methodology/approachThe design was a longitudinal survey of COVID-19 infections, recoveries and fatalities in Nigeria using the data on the daily updates of the Nigeria Centre for Disease Control for the period 1 May to 23 August 2020. Markov chain analysis was performed on the data.FindingsThe results showed that in the long run, 8.4% of the population will be susceptible to COVID-19 infections, 26.4% of them will be infected, 61.2% of the infected will recover and 4% will become fatal. Thus, if this pattern of infections and recoveries continue, the majority of the infected people in Nigeria will recover whilst a very small proportion of the infected people will die.Research limitations/implicationsA dearth of the extant literature on the problem, especially from the management science perspective.Practical implicationsResults of the study will facilitate policymakers’ response to the curtailment of the pandemic in Nigeria.Social implicationsCurtailing the pandemic through the results of this study will assist in easing the social consequences of the pandemic.Originality/valueThe proposed adjustment to the susceptibilities, infections and recoveries model through the introduction of a fourth state (fatality) to get the susceptibilities, infections, recoveries and fatalities model, signalling a point of departure from previous studies.

Evaluation of infection prevention and control practices in Lassa fever treatment centers in north-central Nigeria during an ongoing Lassa fever outbreak.

Outbreaks of Lassa fever (LF) in Nigeria have become more frequent, with increasing more healthcare worker infections. Prevention of infection is dependent on strict compliance to infection prevention and control (IPC) practices in treatment centres where patients are managed. To evaluate IPC practices during an ongoing LF outbreak in the two major tertiary hospitals serving as the referral LF treatment centres in the north-central region of Nigeria. This cross-sectional survey was carried out by the IPC subteam of the National Rapid Response Team of the Nigeria Centre for Disease Control (NCDC) deployed to Plateau State, north-central Nigeria during the 2019 LF outbreak. Information on IPC in these facilities was collected using the NCDC viral haemorrhagic fevers (VHFs) isolation and treatment facility IPC survey tool. Both treatment centres had national VHF IPC isolation guidelines and few health workers had received IPC training. In both centres, there were no clearly demarcated entry points for staff going into clinical areas after putting on personal protective equipment, and there were also no standard operating procedures in place for reporting occupational exposure of staff to infected blood or body fluids in both centres. The LF treatment centers located in Plateau State during the 2019 LF outbreak were not fully implementing the national VHF IPC guidelines. Periodic assessments of IPC are recommended for proper management of cases and effective control of LF in the State.

A Time Series Model to Forecast Covid-19 Infection rate in Nigeria Using Box-Jenkins Method

Coronavirus declared as a global pandemic by WHO has emerged as the most aggressive disease negatively affecting more than 90% countries of the world. Nigeria, one of the most populated countries in Africa is not an exception. This study focuses on analyzing the intrinsic patterns in the COVID-19 spread in Nigeria using the Box-Jenkins procedure. Data of daily confirmed cases of COVID-19 in Nigeria was retrieved from Nigeria Centre for Disease Control (NCDC) official website from February 27, 2020 to October 31, 2020 to identify the series components, estimate parameters, develop an appropriate stochastic predictive model and use the model to forecast future trend of the deadly virus. The Autoregressive Integrated Moving Average (ARIMA) of order (0,1,1) was identified as the most suitable model based on the analysis of the autocorrelation (ACF), partial autocorrelation functions (PACF) and Akaike Information Correction (AICc) value. R software version 4.0.3 was used to analyze the trend which moothen the series by using 8-point moving average to extract the irregular component as wellas differencing the series one step further to obtain a stationary series. We performed the Augmented Dickey-Fuller Unit root test, parameter estimation and Ljung-Box test to check the proposed model’s conformity to the stationary univariate process. A 85 – day (1st Oct., 2020 – 24th Jan., 2020)forecast shows a gradual decline in the successive number of confirmed cases of infection indicating the effectiveness of the intervention strategies employed by the Task Force to contain the virus. The concerned authorities can apply the forecasted trend to make further informed decisions on the measures to be put in place to reduce diffusion of the deadly virus into the country.

Knowledge, perception and practices toward COVID-19 among care receivers attending a University Medical Center in Nigeria: A cross-sectional study

Background: Knowledge is one of the contributing factors formulating the perception and attitude of people towards disease outbreaks, which in turn drives compliance to effective prevention and control measures. The current cross-sectional study assessed the knowledge, perception and practices (KPP) towards COVID-19 pandemic among care receivers attending Ahmadu Bello University medical center (ABUMC) in Zaria, Nigeria. Methods: Data were collected using self-administered questionnaires which covered demographic characteristics and related KPP questions. Responses were tabulated, frequencies and percentages were computed for descriptive purposes, while independent t-test and ANOVA were used to depict statistical differences between demographic groups. Results: Among the 150 participants who answered the questionnaires, 58.7% were female, 62.0% were undergraduate students at various level of studies, 25.5% held a bachelor degree, about half of them (52.7%) never married, and have mean age of 29.90 ±10.66 years. Majority of the participants, especially women are knowledgeable about COVID-19 with overall mean knowledge score of 4.91 ±1.68 (70.14%). Similarly, 16-25years age range, and higher educational status were found to possess significantly (p <0.05) higher mean knowledge score. They hold positive perceptions, and have correct practices towards COVID-19 prevention. However, significant proportion of the participants (12.0%) believed that the disease does not exist in Nigeria. Conclusion: This study has demonstrated that, majority of the care receivers attending ABUMC have good knowledge, perception and practices toward COVID-19. Nevertheless, certain knowledge gaps and bad practices toward the pandemic were equally identified, which highlight the need to reiterate targeted health awareness campaigns about the pandemic in Nigeria.

Sedation of Children undergoing Magnetic Resonance Imaging in a Resource Poor Setting using low doses of Ketamine and Diazepam

We aimed to describe the successful use of low doses of ketamine hydrochloride with diazepam premedication to sedate children with ages between 3days to five years who presented at three diagnostic centres in Port Harcourt Nigeria for magnetic resonance imaging (MRI) within a five-year period. This was done in an environment with no MRI compatible anaesthetic machine and monitoring was done by the anaesthetist within the suites. The average age of the children was ten months with a mean dose of 18mg of ketamine used. The mean duration of the procedures was 44.92 minutes and constant presence of the anaesthetist was required throughout the procedures for monitoring. Two incidences of self-limiting laryngospasm occurred with a safe outcome for all of the patients. Children can be satisfactorily sedated with low doses of ketamine for MRI in some less than ideal situations.