Background The emergency care of time-sensitive injuries and illnesses is increasingly recognized as an essential component of effective health care systems. However, many low- and middle-income countries (LMICs) lack healthcare providers formally trained in the care of emergency conditions. The Disease Control Priorities 3 project estimates that effective emergency care systems could avert up to half of all premature deaths in LMICs. Nigeria, a lower-middle income country of nearly 200 million people in Sub-Saharan Africa, could save approximately 100,000 lives per year with an effective emergency care system. The World Health Organization developed the Basic Emergency Care (BEC) course to train frontline healthcare workers in the management of emergency conditions in low resource settings. In this study we describe our work implementing the BEC course Nigeria. Methods This study was designed as a mixed methods research analysis comparing pre- and post- course examination results and surveys to evaluate participant knowledge acquisition and levels of confidence with management of various emergency conditions. Thirty-two participants were involved in the course which took place over four days at the Lagos University Teaching hospital. Quantitative data was analyzed using Stata 14.2 (College Station, TX). Paired data sets were analyzed using McNemar's chi-squared. Unpaired data sets were analyzed using a Wilcoxon signed-rank test. Results Post-course test scores showed significant improvement (p-value <0.001) as compared to pre-course. The average pre-course test score was 73% and average post-course score was 86.5%. Pre- and post-course questionnaires demonstrated significantly increased confidence in managing emergency conditions and agreement with course objectives. Conclusions The WHO Basic Emergency Care (BEC) course successfully increased the knowledge and confidence of frontline emergency care providers in Nigeria. The course was well received by participants. Future study should focus on BEC course scalability and long-term knowledge retention.

IntroductionEmergency care systems provide timely and relevant care to the acutely ill and injured. Published commentaries have characterised deficiencies in the Nigerian emergency care system and offered potential solutions but have not included the perspectives of the Nigerian public. A more inclusive approach that includes feedback from the public may help improve the Nigerian emergency care system through better understanding of the needs, values and expectations of the community.MethodsParticipants of an emergency medicine symposium participated in focus group discussions that were randomly divided into small groups led by two trained facilitators. These facilitators asked open-ended, semistructured questions to lead discussions in the English language. Participant responses were audio-recorded and transcribed verbatim into transcripts. Two independent investigators employed conventional content analysis to code the transcripts until thematic saturation was achieved.ResultsThree descriptive themes emerged characterising the current state of Nigeria’s emergency care system as it relates to prehospital care delivery, hospital care delivery and health system governance: rudimentary, vulnerable and disconnected. At the prehospital level, concepts revolved around emergency recognition and response, ambulance and frontline providers, and cultural norms. At the hospital level, concepts centred around the health workforce, clinical competency, hospital capacity and the burden of financial hardship. At the health system level, concepts concentrated on healthcare access and healthcare financing. Opportunities for emergency care system improvement at each component level were identified and explored.ConclusionsThe participants in this study identified shortcomings and opportunities to improve prehospital care, hospital care and health system governance. The results of this study may help healthcare professionals, policy makers and community leaders identify gaps in the emergency care system and offer solutions in harmony with the needs, values and expectations of the community. If successful, these community-informed interventions may serve as a model to improve emergency care systems throughout Africa.

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Background Autism Spectrum disorder (ASD) has uniquely stigmatizing aspects because children with ASD have no physical markers of their condition. Parents are usually blamed and judgment from others is often internalized (felt stigma). Aim This study was conducted to determine knowledge about ASD, negative experiences (enacted stigma), internalization of stigma (felt or self stigma) and its correlates among parents of children with ASD in Lagos, Nigeria. Methods This was a cross-sectional study of 230 parents in Lagos, Nigeria employing mixed-method data collection methods. Quantitative data were collected using a structured interviewer-administered questionnaire and analyzed with Epi- Info™ version 7.0 statistical package. Data were summarized with proportions, mean and standard deviation. Chi square and Spearman’s correlation tests were done, and the level of significance was pre-determined at 5% (p < 0.05). In-depth interviews were also conducted among six parents to further explore the topic. The interviews were analyzed narratively. Results The proportion of mothers and fathers were 175 (76.1%) and 55 (23.9%) respectively. The mean age of respondents was 42 ± 8.5 years. Overall knowledge of ASD was very poor as only 3(1.3%) had good knowledge. Overall, 122(53%) usually had negative experience of parenting a child with ASD (enacted stigma), mothers (17.1%) more than fathers (9.1%). Majority 192(83.5%) internalized stigma. There was a low–moderate correlation between ‘enacted’ stigma and ‘internalized’ stigma (ρ- 0.400, p < 0.001). From in-depth interviews, many parents revealed that their child’s condition had negative effects on the family. Many also recounted negative experience of stigma. Conclusion Overall, parents of children with ASD had poor knowledge of the condition. Majority internalized stigma and this increases with negative treatment from others. Parents should be properly educated about ASD. Community-based education to increase awareness about ASD in addition to encouraging people to show empathy and reduce stigmatizing behaviour towards parents of children with ASD are recommended.

Background: Antimicrobial resistance (AMR) has become a public health emergency with increasing rates and spread globally. Antimicrobial stewardship (AMS) has been advocated to reduce the burden of antimicrobial resistance, promote rational and appropriate use of antibiotics and improve clinical outcomes. Education and training are one of the AMS interventions to improve antimicrobial use. We present the roll out of a successful AMS programme with education and training using the Global-PPS as data collection tool to measure AMS interventions and impact.Methodology: This was a cross sectional study on the implementation of an AMS programme at the Lagos University Teaching Hospital. Global PPS was conducted in 2015 to collect baseline data which was used to identify targets for quality improvement in AMS and was repeated in 2017 and 2018 to measure impact of AMS interventions. AMS interventions included education, feedback of Global-PPS result and writing of the hospitalwide antibiotic policy based on the baseline data.Results: Out of the 746 inpatients surveyed, 476 (68.3%) had received at least one antimicrobial on the days of Global-PPS. The antimicrobial prescribing rates reduced significantly over the three time periods. In 2015, 82.5% were placed on antimicrobials, 65.5% in 2017 and 51.1% in 2018 (p<0.00001). The documentation of indication for treatment significantly improved from 53.4% in 2015 to 97.2% in 2018 (p<0.0001). Stop review date also significantly improved from 28.7% to 70.2% in 2018 (p<0.00001). Surgical prophylaxis for more than 24 hours reduced significantly from 93.3% in 2015 to 65.7% in 2018 (p=0.002) even though the prevalence was still high. The three most commonly administered antimicrobial groups were third generation cephalosporins, imidazole derivatives and quinolones. The most commonly prescribed antibiotics for surgical prophylaxis were ceftriaxone and metronidazole in 2015 and ceftriaxone in 2017.Conclusion: The use of education and training as AMS intervention in a limited resource setting clearly made impact on antimicrobial prescribing patterns in the hospital. Global-PPS is useful to set quality improvement targets and for monitoring, evaluation and surveillance of an AMS programme. Keywords: Antibiotic, Stewardship, Resistance, Education, Global-PPS

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Background Solid waste dump sites have proven to have potentially high risk to human health as it serves as a source of air, soil and underground water pollution. Aim This study aimed to assess and compare the knowledge, respiratory disorders and skin disorders between residents living close to and far from landfill sites in Lagos State, Nigeria. Setting Igando (a community within 5 km close to) and Badagry (a community beyond 5 km from) Solous Landfill sites in Lagos state, Nigeria. Methods A comparative cross-sectional study amongst 103 respondents recruited from each of the two study sites by multistage sampling method was carried out. Data were collected using pretested, structured, interviewer-administered questionnaire, and analysed using Microsoft Excel 2007, EPI Info 7 and WinPepi statistical software packages. Student t -test, Fisher’s exact and Chi-square tests were carried out. The p ≤ 0.05 was considered statistically significant. Results The mean age of Igando and Badagry respondents was 34.18 ± 10.21 years and 32.62 ± 9.84 years, respectively. The two communities differed significantly ( p < 0.0001) with respect to distance of workplace from landfill site and duration of stay in the residential location. The mean knowledge score of respondents on respiratory and skin disorders associated with solid waste dump site close to landfill sites (82.53 ± 20.60) was statistically significantly higher than those of respondents far from landfill sites (71.84 ± 20.57) ( p = 0.0003). Respiratory and skin disorders experiences of respondents close to landfill sites were statistically significantly ( p < 0.0001) higher than those of residents far from landfill sites with respect to wheezing, frequent sneezing, unpleasant odour, fever and skin rashes. Conclusion Respiratory and skin disorders experienced by respondents close to landfill sites are higher than those of residents far from landfill sites. Landfill sites should not be located close to human settlements.

Introduction Depression causes and worsens malnutrition. The prevalence of malnutrition in the elderly of the developed world was about 22.6% and about 40% of hospitalized elderly are malnourished while about 4.8% have one major depressive episode in people aged 50 and above. Food rich in omega-3 has antidepressant effect and its low intake is linked with dementia. Decrease dietary folate has been linked with depression. This study was aimed at determining the relationship between depression and nutritional status among the elderly in selected primary healthcare centers (PHC) in Lagos Nigeria. Method A descriptive cross-sectional study was conducted using multi-stage technique to select 219 participants by systematic sampling method from the selected PHC centers. Data was collected using structured interviewer-administered questionnaires. Nutritional status and Depression were assessed using Mini-Nutritional Assessment and Geriatric Depression Scale respectively. Data analysis was carried out using Epi-info 7.1. Associations were tested using Chi-square for categorical variables while t-test and analysis of variance were used for continuous variables. Associations were statistically significant if two-tailed probability was less than 5% (0.05). Results It was found that 57.9% and 47.1% were malnourished and depressed respectively. There was a statistically significant association between the sex of the participants and the nutritional status (p = 0.048). Statistically significant association existed between sex (p = 0.024), marital status (p = &lt;0.001), educational qualification and depression. Statistically significant association between monthly income (p = &lt;0.001), living arrangement (p = 0.002) and depression was demonstrated. There was a statistically significant association between family support (p = &lt;0.001), nutritional status (p = &lt;0.001) and depression. There was statistically significant difference between the height (p = 0.00885), weight (p = 0.00052, waist-hip ratio (p = 0.036) and the nutritional status. Remarkably, there was statistically significant difference between the waist (p = 0.023) and hip circumference (p = 0.047) and their level of depression. Conclusion A high prevalence of poor nutritional status and depression existed among the elderly primary healthcare centers.