Local Government Area Level Research Articles

Using spatial analysis to examine inequalities and temporal trends in food retail accessibility.

In this paper, we examined whether there are inequalities in access to food retail (by type and healthiness) across local government areas (LGA) in Greater Melbourne and by LGA grouped based on their distance from the central business district and Growth Area designation. We also examined whether these inequalities persisted over time. This is a secondary analysis of a repeated cross-sectional census of food outlets collected at four time points (2008, 2012, 2014 and 2016) across 31 LGA. Using Geographical Information Systems, we present a spatial analysis of food retail environments in Melbourne, Australia, at these four times over eight years. Greater Melbourne, Australia. 31 LGA in Greater Melbourne. Findings show significant inequalities in access to healthy food retail persisting over time at the LGA level. Residents in lower density urban growth areas had the least access to healthy food retail. Unhealthy food retail was comparatively more accessible, with a temporal trend indicating increased accessibility over time in urban growth areas only. Accessibility to food outlets, particularly healthy food outlets and supermarkets, in Greater Melbourne is not equal. To identify and address health inequalities associated with rapid urban growth, further understanding of how people interact with the food environment needs to be explored.

Cost of COVID-19 vaccine delivery in nine States in Nigeria via the U.S. Government Initiative for Global Vaccine Access

BackgroundIn 2022, the U.S. Centers for Disease Control and Prevention collaborated with implementing partners, African Field Epidemiology Network and Sydani Group, to support COVID-19 vaccination efforts in Nigeria. To characterize the costs of COVID-19 vaccination, this study evaluated financial costs per dose for activities implemented to support the intensification campaign for COVID-19 vaccination.MethodsThis retrospective evaluation collected secondary data from existing expenditure and programmatic records on resource utilization to roll out COVID-19 vaccination during 2022. The study included incremental financial costs of the activities implemented to support an intensification campaign for COVID-19 vaccination across nine states and six administrative levels in Nigeria from the perspective of the external donor (U.S. Government). Costs for vaccines and injection supplies, transport of vaccines, and any economic costs, including government in-kind contributions, were not included. All costs were converted from Nigerian Naira to 2022 U.S. Dollars (US$).ResultsThe estimated financial delivery cost of the COVID-19 vaccination intensification campaign was US$0.84 per dose (total expenditure of US$6.29 million to administer 7,461,971 doses). Most of the financial resources were used for fieldwork activities (86%), followed by monitoring and supervision activities (8%), coordination activities (5%), and training-related activities (1%). Labor (58%) and travel (37%) were the resource inputs that accounted for the majority of the cost, while shares of other resource inputs were marginal (1% for each). Most labor costs (79%) were spent on payments for mass vaccination campaign teams, including pay-for-performance incentives. By administrative level, the largest share of costs (46%) was for pay-for-performance incentives at the community, health facility, or campus levels combined, followed by local government area level (24%), community level only (15%), state level (9%), national level (3%), campus level only (1%), and health facility level only (< 1%).ConclusionsFindings from the evaluation can help to inform resources needed for vaccination activities to respond to future outbreaks and pandemics in resource-limited settings, particularly to reach new target populations not regularly included in routine childhood immunization delivery.

Evaluation of the Administrative, Coordination, and Financing Capacity of the Sub-National Malaria Elimination Programs in Nigeria: A Case Study of Cross River State.

Background: This study appraised the implementers’ perspective of the program’s existing administrative and management; coordination and collaboration; and financing and accountability capacities to deliver its malaria prevention and control mandate. Method: The instrument used was a structured interviewer-administered questionnaire adapted from an already existing National Malaria Programme’s Capacity Assessment tool. Being a widely used open-source program tool, a pretest was done to ascertain its suitability and applicability to the study context and for field assistants to gain familiarity with it. The total population sampling method was used due to the small size of the target population. The target population/sample size was therefore 137, comprising the State Malaria Technical Working Group members, key officers of Cross River State Malaria Elimination Program (CRSMEP), and the Local Government Areas (LGA) Malaria implementing teams. It was a descriptive cross-sectional study. Each element per section of the questionnaire was weighted using the Likert scale and calculated using simple percentages. Results: Research results showed that the malaria program at the State and LGA level have adequate administrative and management capacity with confirmation by 64% and 82.1% of respondents respectively. 80% of respondents confirmed average coordination and collaboration capacity at the State level while 50% of respondents at the LGA level confirmed that the program has adequate coordination and collaboration capacity. For financing and accountability capacity, 36% of respondents affirmed that there is average capacity at the State level while 37.5% confirmed that there is no capacity at LGA level. Conclusion: The study revealed the program’s capacity gaps at State and LGA in the 3 aforementioned key areas. Therefore, interventions to address the capacity gaps are training/re-training of program staff and health workers on program management, administration, and finance, establishing performance management and accountability mechanisms, conducting evidence-based advocacy visits to policymakers for prioritizing allocating and releasing funds for malaria control activities, especially for intervention areas that are not supported by donor/partner organizations.

Evaluation of the administrative, coordination and financing capacity of the sub-national malaria elimination programs in Nigeria: a case study of cross river state.

This study appraised the implementers' perspective of the program's existing administrative and management; coordination and collaboration; and financing and accountability capacities to deliver its malaria prevention and control mandate. The instrument used was a structured interviewer-administered questionnaire adapted from an already existing National Malaria Programme's Capacity Assessment tool. Being a widely used open-source program tool, a pretest was done to ascertain its suitability and applicability to the study context and for field assistants to gain familiarity with it. The total population sampling method was used due to the small size of the target population. The target population/sample size was therefore 137, comprising the State Malaria Technical Working Group members, key officers of Cross River State Malaria Elimination Program (CRSMEP), and the Local Government Areas (LGA) Malaria implementing teams. It was a descriptive cross-sectional study. Each element per section of the questionnaire was weighted using the Likert scale and calculated using simple percentages. Research results showed that the malaria program at the State and LGA level have adequate administrative and management capacity with confirmation by 64 and 82.1% of respondents respectively. 80% of respondents confirmed average coordination and collaboration capacity at the State level while 50% of respondents at the LGA level confirmed that the program has adequate coordination and collaboration capacity. For financing and accountability capacity, 36% of respondents affirmed that there is average capacity at the State level while 37.5% confirmed that there is no capacity at LGA level. The study revealed the program's capacity gaps at State and LGA in the 3 aforementioned key areas. Therefore, interventions to address the capacity gaps are training/re-training of program staff and health workers on program management, administration, and finance, establishing performance management and accountability mechanisms, conducting evidence-based advocacy visits to policymakers for prioritizing allocating and releasing funds for malaria control activities, especially for intervention areas that are not supported by donor/partner organizations.

A holistic approach to well-being and neglected tropical diseases: evaluating the impact of community-led support groups in Nigeria using community-based participatory research.

Neglected tropical diseases (NTDs) affect around 1 billion people, many living in the poorest parts of the world. NTDs often lead to serious long-term physical impairments. Stigma, disability, poverty and social isolation interact, resulting in poor quality of life and significant psychosocial impacts. The holistic health and psychosocial needs of persons affected by NTDs are often overlooked in integrated NTD programme design and research. Furthermore, the viewpoints of persons affected are often absent and spaces for empowerment and advocacy are limited. Using a community-based participatory research design, our study partnered with persons affected and caregivers as co-researchers to address this gap. Through the process, we co-designed and implemented community-based support groups in Kaduna and Kwara, Nigeria, where NTDs are endemic. This paper utilises photovoice with support group facilitators (persons affected); participant observation of group meetings; rapid micronarratives with support group members; and key informant interviews with programme implementers at the state and local government area levels to explore the impact of the support groups from the perspective of people affected by NTDs and other health system actors. Perceived impacts of the support groups included a sense of ownership and empowerment, stigma reduction, improved self-esteem, improved health knowledge and health outcomes and capacity strengthening through vocational training. Support groups, as community spaces of healing, offer a low-cost holistic intervention for chronic disease and disability.

Using Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) Framework to Assess the Effect of a Multicomponent Intervention on Routine Immunization Data Quality in Lagos State

ABSTRACT Background: Quality data can be used to monitor immunization program performance and targets, reveal reasons for poor program performance, and provide evidence for decision-making at the frontlines. Challenges hampering immunization data quality include weak human resource capacity, weak monitoring supervision, and nonexistent or ineffectual feedback on data quality and use, especially at subnational levels. Interventions bordering on upskilling of available human resource capacity and supportive supervision can improve immunization system performance. We implemented a multicomponent intervention (training, supportive supervision, and peer mentoring) among health workers in Lagos to assess the reach (proportion of immunization staff who were reached), adoption (proportion of immunization staff who participated and completed the intervention), and effectiveness (data accuracy, completeness, timeliness, and quality index (QI) scores) of a multicomponent intervention on immunization data quality in Lagos State. Methods: This was a quasi-experimental study that employed a mixed-methods (quantitative and qualitative) approach to assess the reach, effectiveness, and adoption of the interventions. A pre- and posttest design was employed for the quantitative aspect of the study. The reach and adoption were assessed using a process indicator questionnaire, while the effectiveness of the intervention was assessed using the Data Quality Assessment (DQS) tool to obtain the accuracy ratio (AR) and detect any significant variation in the data recorded in the health facility (HF) registers, tally sheets, and District Health Information System version 2 for the pre- and post-intervention period. A total of 32 key informant interviews (KIIs) (eight KIIs in each local government area (LGA)) were conducted with respondents being key workers who were purposively selected. Data from both methods were triangulated and used to support the findings. Results: The study had a reach of 91% and a participation and completion (adoption) rate of 100%. At the HF level, the accuracy of data submitted (tally sheet vs immunization register) showed the most significant improvement from pre-intervention (11.8%) to post-intervention (100%) in one LGA, Second rural Local Government Area (R-IKD 2). Facilities in two LGAs, such as First urban Local Government Area U-IKJ 1 (64.7% to 94.1%) and Second urban Local Government Area U-LM 2 (88.2 to 100%) LGAs, showed the most significant improvement in timeliness and completeness of submitted reports, respectively. For QI scores, at the LGA level, the most significant improvement was recorded in the evidence of using the data domain (50% to 100%) for one LGA, U-IKJ 1. Conclusion: Challenges that hamper immunization data quality such as weak human resource capacity, weak monitoring, and supervision can be improved with a multicomponent intervention targeted at upskilling available human resource capacity and supportive supervision to strengthen immunization system performance.

Regionalised greenhouse gas emissions from food production in South-Eastern Australia

Agriculture is a significant source of greenhouse gases (GHG). Agriculture GHG emissions are often quantified at national or state level, with local-scale emissions not available to inform the state's regional policies and local government and community action to mitigate climate change. We present spatial inventories of GHG from food production for the state of New South Wales in Australia for methane (CH 4 ), nitrous oxide (N 2 O) and the sum of the two GHG in carbon dioxide equivalent (CO 2 -e). We used a top-down approach to disaggregate emissions from state level reported in the State and Territory Greenhouse Gas Inventories to emissions at local government area level using publicly available agricultural census data. Our estimates showed that regional local government areas accounted for 18,522,010 t of CO 2− e, 572,707 t of CH 4 and 10,785 t of N 2 O emissions for food production, while metropolitan local government areas (Greater Sydney) accounted for 104,057 t of CO 2− e, 2313 t of CH 4 and 151 t of N 2 O emissions for food production. Livestock emissions dominated most regional local government areas, contributing on average (median) 14 times more emission than cropping emissions. Our study applies an approach for a transparent estimate of local-scale emissions consistent with the Australian national inventory. To supplement the food production emissions inventory, a spatial food consumption-based inventory using emission factors derived by Hendrie et al. (2016) is presented to illustrate the importance of engaging cities when addressing GHG emissions from food systems. Sources and spatial trends in food production-based and consumption-based emissions in New South Wales are addressed to guide policymakers and communities on opportunities to mitigate associated emissions to address climate goals.

Descriptive epidemiology of poliomyelitis cases due to wild poliovirus type 1 and wild poliovirus type 3 in Nigeria, 2000-2020.

in August 2020, the World Health Organization African Region was certified free of wild poliovirus (WPV) when Nigeria became the last African country to interrupt wild poliovirus transmission. The National Polio Emergency Operations Center instituted in 2012 to coordinate and manage Nigerian polio eradication efforts reviewed the epidemiology of WPV cases during 2000-2020 to document lessons learned. we analyzed reported WPV cases by serotype based on age, oral poliovirus vaccine immunization history, month and year of reported cases, and annual geographic distribution based on incidence rates at the Local Government Area level. The observed trends of cases were related to major events and the poliovirus vaccines used during mass vaccination campaigns within the analysis period. a total of 3,579 WPV type 1 and 1,548 WPV type 3 laboratory-confirmed cases were reported with onset during 2000-2020. The highest WPV incidence rates per 100,000 population in Local Government Areas were 19.4, 12.0, and 11.3, all in 2006. Wild poliovirus cases were reported each year during 2000-2014; the endemic transmission went undetected throughout 2015 until the last cases in 2016. Ten events/milestones were highlighted, including insurgency in the northeast which led to a setback in 2016 with four cases from children previously trapped in security-compromised areas. Nigeria interrupted WPV transmission despite the challenges faced because of the emergency management approach, implementation of mass vaccination campaigns, the commitment of the government agencies, support from global polio partners, and special strategies deployed to conduct vaccination and surveillance in the security-compromised areas.

Assessment of Tropical Cyclone Risk to Coral Reefs: Case Study for Australia

In this study, we attempt to expand tropical cyclone (TC) risk assessment methodology and build an understanding of TC risk to Australia’s natural environment by focusing on coral reefs. TCs are natural hazards known to have the potential to bring destruction due to associated gale-force winds, torrential rain, and storm surge. The focus of TC risk assessment studies has commonly centred around impacts on human livelihoods and infrastructure exposed to TC events. In our earlier study, we created a framework for assessing multi-hazard TC risk to the Australian population and infrastructure at the Local Government Area level. This methodology is used in this study with coral reefs as the focus. TC hazard, exposure, and vulnerability indices were created from selected coral-related datasets to calculate an overall TC risk index for the Ningaloo Reef (NR) and the Great Barrier Reef (GBR) regions. The obtained results demonstrate that the northern NR and the southern GBR had the highest risk values within the study area; however, limitations in data quality have meant that results are estimates at best. The study has shown the potential benefits of such a TC risk assessment framework that can be improved upon, as coral data collection becomes more readily available.

Lessons learnt from decentralization of COVID-19 response in a southwest state of Nigeria

Introduction: This report shows the outcomes and lessons learnt from a 3-month intervention focused on decentralization of COVID-19 coordination, testing and contact tracing activities in three hotspot local government areas (LGAs) of a state in the southwest of Nigeria. Methods: A description of COVID-19 outbreak response from the occurrence of the index case was documented. A health facility and community-based intervention implemented in three hotspots LGA as part of response to COVID-19 pandemic from 24th May to 22nd August, 2021 was described. The interventions implemented focused on integrating COVID-19 testing into routine healthcare services in 103 health facilities, engagement of community-based volunteers to conduct contact tracing, and improving coordination of the response through the conduct of incident management meetings at state and LGA levels. The COVID-19 dataset from 22nd February to 22nd August, was obtained from the State Ministry of Health and analyzed. Data were summarized using charts and maps. Results: A higher number of cases (3879) were tested between 24th May to 22nd August, 2021 (during intervention) compared to 1667 cases tested between 23 February to 23 May, 2021 (before intervention) across the three LGAs. Generally, there was a decline in the cumulative number of contacts traced and line-listed during the intervention (778) compared to the period before the intervention (1170) in two of the three LGAs. The number of weekly incident management meetings held improved by 25% at State level, while 83% of weekly LGA meetings were held at the three hot spot LGAs during the intervention compared to the period before the intervention, where no meeting was held at LGA level. Conclusions: The decentralization of the COVID-19 outbreak response from a central approach to the LGA level improved only testing numbers and the number of incident management meetings conducted across the three hot spot LGAs. The number of contacts line-listed, positivity rate and reported cases reduced following the interventions. The need to supplement contact tracing activities using information technology for self-report as done in other climes, as well as engaging community, religious leaders and key community groups as integral members of the contact tracing team was emphasized.

Spatiotemporal heterogeneity and determinants of canine rabies evidence at Local Government Area Level in Nigeria: Implications for rabies prevention and control

Canine rabies poses a significant risk to humans and animals in Nigeria. However, the lack of reliable tools to evaluate the performance of existing canine rabies control programs to inform public health policy decisions poses a severe obstacle. We obtained canine rabies surveillance data from the National Veterinary Research Institute (NVRI) and supplemented these data with rabies diagnoses reported in the published studies from Nigeria. To uncover contextual factors (i.e., environmental and sociodemographic) associated with canine rabies evidence at the Local Government Area (LGA) level, we classified LGAs in Nigeria into four categories based on evidence availability (i.e., LGAs with NVRI data or published studies, both, or no evidence). We described the geographical and temporal variation in coverage. We fitted a multinomial regression model to examine the association between LGA level canine rabies evidence and potential sociodemographic and ecological determinants of canine rabies evidence. The effective annual testing during the 19 years was less than one dog/100,000 Nigerian resident-year. Our results showed that 58% of Nigerian LGAs (450/774) had not been targeted by the existing national rabies surveillance or studies on rabies, including ten states capitals with high human populations. While 16% (122/774) of Nigerian LGAs concentrated in Taraba, Adamawa, and Abia had canine rabies evidence from published studies, none of these LGAs was represented in the NVRI rabies surveillance data. We also observed an increasing trend in rabies evidence over time towards the eastern part of Nigeria. Our multinomial regression model indicated that education level, poverty, population density, land use and temperature were significantly associated with canine rabies evidence at the LGA level. This study underscores the value of combining canine rabies evidence from different sources to better understand the current disease situation for targeted intervention.

Strengthening facility-based immunization service delivery in local government areas at high risk for polio in Northern Nigeria, 2014-2015.

IntroductionThe National Stop Transmission of Polio (NSTOP) program was created in 2012 to support the Polio Eradication Initiative (PEI) in Local Government Areas (LGAs) at high risk for polio in Northern Nigeria. We assessed immunization service delivery prior to the commencement of NSTOP support in 2014 and after one year of implementation in 2015 to measure changes in the implementation of key facility-based Routine Immunization (RI) components.MethodsThe pre- and post-assessment was conducted in selected health facilities (HFs) in 61 LGAs supported by NSTOP in 5 states. A standardized questionnaire was administered to the LGA and HF immunization staff by trained interviewers on key RI service delivery components.ResultsAt the LGA level, an increase was observed in key components including availability of updated Reach Every Ward (REW) micro-plans with identification of hard to reach settlements (65.6% baseline, 96.8% follow-up, PR = 1.5 (95% CI 3.4 - 69.8), vaccine forecasting (77.1% baseline, 93.5% follow-up, PR =1.2 (95% CI 1.8 - 13.8), and timely delivery of monthly immunization reports (73.8% baseline, 90.2% follow-up; PR =1.2 (95% CI 1.2 - 9.0). At the HF level, there was an increase in percentage of HFs with written supervisory feedback (44.5% baseline, 82.5% follow-up, PR = 1.8 (95% CI 4.7 - 7.3), written stock records (66.5% baseline, 87.9% follow-up, PR = 1.3 (95% CI 2.9 - 4.7) and updated immunization monitoring charts (76.3% baseline, 95.6% follow-up, PR = 1.3 (95% CI 4.6 - 9.9).ConclusionWe observed an improvement in key RI service delivery components following implementation of NSTOP program activities in supported LGAs.

Use of a district health information system 2 routine immunization dashboard for immunization program monitoring and decision making, Kano State, Nigeria.

Introductiona district health information system 2 tool with a customized routine immunization (RI) module and indicator dashboard was introduced in Kano State, Nigeria, in November 2014 to improve data management and analysis of RI services. We assessed the use of the module for program monitoring and decision-making, as well as the enabling factors and barriers to data collection and use.Methodsa mixed-methods approach was used to assess user experience with the RI data module and dashboard, including 1) a semi-structured survey questionnaire administered at 60 health facilities administering vaccinations and 2) focus group discussions and 16 in-depth interviews conducted with immunization program staff members at the local government area (LGA) and state levels.Resultsin health facilities, a RI monitoring chart was used to review progress toward meeting vaccination coverage targets. At the LGA, staff members used RI dashboard data to prioritize health facilities for additional support. At the State level, immunization program staff members use RI data to make policy decisions. They viewed the provision of real-time data through the RI dashboard as a “game changer”. Use of immunization data is facilitated through review meetings and supportive supervision visits. Barriers to data use among LGA staff members included inadequate understanding of the data collection tools and computer illiteracy.Conclusionthe routine immunization data dashboard facilitated access to and use of data for decision-making at the LGA, State and national levels, however, use at the health facility level remains limited. Ongoing data review meetings and training on computer skills and data collection tools are recommended.

An assessment of the contribution of National Stop Transmission of Polio Program to Nigeria's Immunization Program.

IntroductionIn July 2012, the National Stop Transmission of Polio (NSTOP) program was established to support the Government of Nigeria in interrupting transmission of poliovirus and strengthen routine immunization (RI). NSTOP has approximately 300 staff members with the majority based at the Local Government Area (LGA) level in northern Nigeria.MethodsAn internal assessment of NSTOP was conducted from November 2015 to February 2016 to document the program´s contribution to Nigeria´s immunization program and plan future NSTOP engagement. A mixed methods design was used, with data gathered from health facility, LGA, state, and national levels, through structured surveys, interviews, focus group discussions, and review of program records. Survey and expenditure data were summarized by frequency and trends over time, while interview and focus group data were analyzed qualitatively for key themes.ResultsThe majority of the 111 non-NSTOP LGA respondents reported that NSTOP officers supported polio campaigns (100%) and supervised RI sessions (99.1%). Out of 181 respondents at health facility level, the majority reported that NSTOP trainings improved their knowledge (83.3%) and skills (76.2%) on RI, and NSTOP officers regularly supervised their RI sessions (96.7%). Most respondents reported that there would be a negative impact on immunization activities if NSTOP officers were withdrawn.ConclusionFuture implementation of NSTOP should be realigned to (a) give highest priority to mentoring LGA staff to build institutional capacity, (b) ensure increased capacity translates to improved provision of RI services, and (c) improve routine review of program monitoring data to assess progress in both polio and RI programs.

What do malaria program officers want to learn? A survey of perspectives on a proposed malaria short course in Nigeria.

In disease control, the program officers are vital to the successful implementation of control strategies. However, poor knowledge of the disease and its control, staff attrition, and lack of intentional training for new staff can lead to under-performance and ineffectiveness of interventions. Thus, the Nigeria Field Epidemiology and Laboratory Training Program, in collaboration with National Malaria Elimination Program, planned a malaria short course (MSC) to strengthen the capacity of current program managers and incoming staff. To guide the development of the curriculum for the MSC, we conducted a needs assessment survey to ascertain the perceived usefulness of the MSC, the priority rating of MSC thematic domains and associated factors. Overall, 384 purposively selected respondents across ten states and the Federal Capital Territory in Nigeria were interviewed. These comprised malaria and non-malaria control program staff at state, local government area (LGA) and ward levels. We administered a structured questionnaire to elicit information on socio-demographics, training needs, priority malaria thematic domains, perceived course usefulness and willingness of ministries/organizations to release staff to attend the MSC. Data were analyzed using descriptive and inferential statistics at p<0.05. Mean age was 43.9 (standard deviation: 7.6 years), 172 (44.8%) were females. Of the 384 respondents, 181 (47.1%), 144 (37.5%) and 59 (15.4%) were at the ward, LGA and state levels, respectively. Seventy-two (18.8%) had never worked in malaria control program. Majority (98.7%, n = 379) reported the need for further training, 382 (99.5%) opined that the course would be useful, and all affirmed their employers' willingness towards their participation at the training. Respondents rated high the domains of basic malariology, malaria treatment, malaria prevention, surveillance/data management, use of computers, leadership skills, program management and basic statistics. Predictors of malaria topical domains' high rating were gender (odds ratio (OR) = 6.77; 95% CI:3.55-12.93) and educational qualifications (OR = 0.48; 95% CI:0.26-0.89). A malaria short course is a necessity and appropriate for program officers at different levels of health administration in Nigeria to achieve malaria elimination, taking into consideration the challenges of human resource retention. The outcome of this study should inform the curriculum and the delivery of the MSC.

Geographical Disparities in HIV Seroprevalence Among Men Who Have Sex with Men and People Who Inject Drugs in Nigeria: Exploratory Spatial Data Analysis.

BackgroundThe assessment of geographical heterogeneity of HIV among men who have sex with men (MSM) and people who inject drugs (PWID) can usefully inform targeted HIV prevention and care strategies.ObjectiveWe aimed to measure HIV seroprevalence and identify hotspots of HIV infection among MSM and PWID in Nigeria.MethodsWe included all MSM and PWID accessing HIV testing services across 7 prioritized states (Lagos, Nasarawa, Akwa Ibom, Cross Rivers, Rivers, Benue, and the Federal Capital Territory) in 3 geographic regions (North Central, South South, and South West) between October 1, 2016, and September 30, 2017. We extracted data from national testing registers, georeferenced all HIV test results aggregated at the local government area level, and calculated HIV seroprevalence. We calculated and compared HIV seroprevalence from our study to the 2014 integrated biological and behavioural surveillance survey and used global spatial autocorrelation and hotspot analysis to highlight patterns of HIV infection and identify areas of significant clustering of HIV cases.ResultsMSM and PWID had HIV seroprevalence rates of 12.14% (3209/26,423) and 11.88% (1126/9474), respectively. Global spatial autocorrelation Moran I statistics revealed a clustered distribution of HIV infection among MSM and PWID with a <5% and <1% likelihood that this clustered pattern could be due to chance, respectively. Significant clusters of HIV infection (Getis-Ord-Gi* statistics) confined to the North Central and South South regions were identified among MSM and PWID. Compared to the 2014 integrated biological and behavioural surveillance survey, our results suggest an increased HIV seroprevalence among PWID and a substantial decrease among MSM.ConclusionsThis study identified geographical areas to prioritize for control of HIV infection among MSM and PWID, thus demonstrating that geographical information system technology is a useful tool to inform public health planning for interventions targeting epidemic control of HIV infection.

A multi-level spatio-temporal analysis on prostate cancer outcomes

BackgroundGeographic and temporal variation in positive surgical margins (PSM) for prostate cancer after radical prostatectomy (RP) has been observed. However, it is unclear how much of this variation could be attributed to patient, surgeon, institution, or socioeconomic-related factors and the impact of PSM on death among localized prostate cancer patients. MethodsThis study aimed to assess the independent and relative contribution of the patient, surgeon, institution and area-level risk factors on geographic and temporal variation of PSM and evaluate the impact of PSM on five-year all-cause and prostate cancer-specific mortality among localized prostate cancer patients. Within the hierarchical-related regression approach, we utilised Bayesian spatial-temporal multi-level models to study individual and area-level predictors with the outcomes, while accounting for geographically structured and unstructured correlation and non-linear trends. ResultsIndividual-level data included 10,075 localized prostate cancer cases with RP reported to the Prostate Cancer Outcomes Registry Victoria between 2009 and 2018. Area-level data comprised socio-economic disadvantage and remoteness data at the local government area level in Victoria, Australia. 26 % of patients had PSM, and the rates varied across areas by years. This variation was mainly associated with NCCN risk, followed by RP techniques, surgical institution type, surgeon volume and socio-economic disadvantage. Intermediate (Odds ratio/OR = 1.21,95 % credible interval/Crl = 1.05−1.41), high/very-high risk groups (OR = 2.24,95 % Crl = 1.91−2.64) and public surgical institution (OR = 1.64, 95 % Crl = 1.46−1.84) were independently associated with a higher likelihood of PSM. Robot-assisted (OR = 0.61, 95 % Crl = 0.55−0.68), laparoscopic RP (OR = 0.76, 95 % Crl = 0.62−0.93), high-volume surgeon (OR = 0.84, 95 % Crl = 0.76−0.93) and socio-economically least disadvantaged status (OR = 0.78, 95 % Crl = 0.64−0.94) showed a lower likelihood of PSM. PSM was also independently associated with a higher five-year all-cause and prostate cancer-specific mortality. ConclusionAggressive tumour characteristics and RP techniques were the main contributors to the likelihood of PSM following RP. Reducing the prevalence of PSM will generally improve prostate cancer-specific and all-cause mortality.

Causes of short birth interval (kunika) in Bauchi State, Nigeria: systematizing local knowledge with fuzzy cognitive mapping

BackgroundShort birth intervals, defined by the World Health Organization as less than 33 months, may damage the health and wellbeing of children, mothers, and their families. People in northern Nigeria recognise many adverse effects of short birth interval (kunika in the Hausa language) but it remains common. We used fuzzy cognitive mapping to systematize local knowledge of causes of kunika to inform the co-design of culturally safe strategies to address it.MethodsMale and female groups in twelve communities built 48 maps of causes and protective factors for kunika, and government officers from the Local Government Area (LGA) and State made four maps. Each map showed causes of kunika or no-kunika, with arrows showing relationships with the outcome and between causes. Participants assigned weights for the perceived strength of relationships between 5 (strongest) and 1 (weakest). We combined maps for each group: men, women, and government officers. Fuzzy transitive closure calculated the maximum influence of each factor on the outcome, taking account of all relationships in the map. To condense the maps, we grouped individual factors into broader categories and calculated the cumulative net influence of each category. We made further summarised maps and presented these to the community mapping groups to review.ResultsThe community maps identified frequent sex, not using modern or traditional contraception, and family dynamics (such as competition between wives) as the most influential causes of kunika. Women identified forced sex and men highlighted lack of awareness about contraception and fear of side effects as important causes of kunika. Lack of male involvement featured in women’s maps of causes and in the maps from LGA and State levels. Maps of protective factors largely mirrored those of the causes. Community groups readily appreciated and approved the summary maps resulting from the analysis.ConclusionsThe maps showed how kunika results from a complex network of interacting factors, with culture-specific dynamics. Simply promoting contraception alone is unlikely to be enough to reduce kunika. Outputs from transitive closure analysis can be made accessible to ordinary stakeholders, allowing their meaningful participation in interpretation and use of the findings.Plain English summaryFor people in Bauchi State, northern Nigeria, kunika describes a short interval between successive births, understood as becoming pregnant again before the previous child is weaned. They recognise it is bad for children, mothers and households. We worked with 12 communities in Bauchi to map their knowledge of the causes and protective factors for kunika. Separate groups of men and women built 48 maps, and government officers at local and state level built four maps. Each group drew two maps showing causes of kunika or of no-kunika with arrows showing the links between causes and the outcome. Participants marked the strength of each link with a number (between 5 for the strongest and 1 for the weakest). We combined maps for women, men and government officers. We grouped similar causes together into broader categories. We calculated the overall influence of each category on kunika or no-kunika and produced summary maps to communicate findings.The maps identified the strongest causes of kunika as frequent sex, not using modern or traditional contraception, and family dynamics. Women indicated forced sex as an important cause, but men focused on lack of awareness about contraception and fear of side effects. The maps of protective factors mirrored those of the causes. The groups who created the maps approved the summary maps. The maps showed the complex causes of kunika in Bauchi. Promoting contraception is unlikely to be enough on its own to reduce kunika. The summary maps will help local stakeholders to co-design culturally safe ways of reducing kunika.

The cholera risk assessment in Kano State, Nigeria: A historical review, mapping of hotspots and evaluation of contextual factors.

Nigeria is endemic for cholera since 1970, and Kano State report outbreaks annually with high case fatality ratios ranging from 4.98%/2010 to 5.10%/2018 over the last decade. However, interventions focused on cholera prevention and control have been hampered by a lack of understanding of hotspot Local Government Areas (LGAs) that trigger and sustain yearly outbreaks. The goal of this study was to identify and categorize cholera hotspots in Kano State to inform a national plan for disease control and elimination in the State. We obtained LGA level confirmed and suspected cholera data from 2010 to 2019 from the Nigeria Centre for Disease Control (NCDC) and Kano State Ministry of Health. Data on inland waterbodies and population numbers were obtained from online sources and NCDC, respectively. Clusters (hotspots) were identified using SaTScan through a retrospective analysis of the data for the ten-year period using a Poisson discrete space-time scan statistic. We also used a method newly proposed by the Global Task Force on Cholera Control (GTFCC) to identify and rank hotspots based on two epidemiological indicators including mean annual incidence per 100 000 population of reported cases and the persistence of cholera for the study period. In the ten-year period, 16,461 cholera cases were reported with a case fatality ratio of 3.32% and a mean annual incidence rate of 13.4 cases per 100 000 population. Between 2010 and 2019, the most severe cholera exacerbations occurred in 2014 and 2018 with annual incidence rates of 58.01 and 21.52 cases per 100 000 inhabitants, respectively. Compared to 2017, reported cases and deaths increased by 214.56% and 406.67% in 2018. The geographic distribution of outbreaks revealed considerable spatial heterogeneity with the widest in 2014. Space-time clustering analysis identified 18 out of 44 LGAs as high risk for cholera (hotspots) involving both urban and rural LGAs. Cholera clustered around water bodies, and the relative risk of having cholera inside the hotspot LGA were 1.02 to 3.30 times higher than elsewhere in the State. A total of 4,894,144 inhabitants were in these hotspots LGAs. Of these, six LGAs with a total population of 1.665 million had a relative risk greater than 2 compared to the state as a whole. The SaTScan (statistical) and GTFCC methods were in agreement in hotspots identification. This study identified cholera hotspots LGAs in Kano State from 2010–2019. Hotspots appeared in both urban and rural settings. Focusing control strategies on these hotspots will facilitate control and eliminate cholera from the State.

Association between Receipt of Guideline-Concordant Lung Cancer Treatment and Individual- and Area-Level Factors: A Spatio-Temporal Analysis.

Guideline-concordant treatment (GCT) of lung cancer has been observed to vary across geographic regions over the years. However, there is little evidence as to what extent this variation is explained by differences in patients' clinical characteristics versus contextual factors, including socioeconomic inequalities. This study evaluated the independent effects of individual- and area-level risk factors on geographic and temporal variation in receipt of GCT among patients with lung cancer. Receipt of GCT was defined on the basis of the National Comprehensive Cancer Network guidelines. We used Bayesian spatial-temporal multilevel models to combine individual and areal predictors and outcomes while accounting for geographically structured and unstructured correlation and linear and nonlinear trends. Our study included 4,854 non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) cases, reported to the Victorian Lung Cancer Registry between 2011 and 2018. Area-level data comprised socioeconomic disadvantage and remoteness data at the local government area level in Victoria, Australia. Around 60.36% of patients received GCT, and the rates varied across geographic areas over time. This variation was mainly associated with poor performance status, advanced clinical stages, NSCLC types, public hospital insurance, area-level deprivation, and comorbidities. This study highlights the need to address disparities in receipt of GCT among patients with lung cancer with poor performance status, NSCLC, advanced clinical stage, stage I-III SCLC, stage III NSCLC, public hospital insurance, and comorbidities, and living in socioeconomically disadvantaged areas. Two-year mortality outcomes significantly improved with GCT. Interventions aimed at reducing these inequalities could help to improve lung cancer outcomes.