The authors acknowledge the support of the Nigeria Federal Ministry of Health and the WHO Nigeria Country Office in the conduct of this study. Special thanks to Victoria Nyawira Nyaga for checking through our statistical analyses. Authorship declaration: DA conceived and designed the study. DA, DQA and AA conducted the literature searches and data extraction. DA, DQA and EOO wrote the first draft. DA and MBA conducted the analysis. DA, AA, RGM, MTD, CO, NE, MOH, WA and IFA contributed to the final draft and checked for important intellectual content. All authors approved the manuscript as submitted.

Background Current knowledge on the burden of, and interactions between malaria and helminth co-infections, as well as the impact of the dual infections on anaemia, remains inconclusive. We have conducted a systematic review with meta-analysis to update current knowledge as a first step towards developing and deploying coordinated approaches to the control and, ultimately, elimination of malaria-helminth co-infections among children living in endemic countries. Methodology/Principal findings We searched Medline, Embase, Global Health and Web of Science from each database inception until 16 March 2020, for peer-reviewed articles reporting malaria-helminth co-infections in children living in a LMIC. No language restriction was applied. Following removal of duplicates, two reviewers independently screened the studies for eligibility. We used the summary odds ratio (OR) and 95% confidence intervals (CI) as a measure of association (random-effects model). We also performed Chi-square heterogeneity test based on Cochrane’s Q and evaluated the severity of heterogeneity using I2 statistics. The included studies were examined for publication bias using a funnel plot and statistical significance was assessed using Egger’s test (bias if p<0.1). Fifty-five of the 3,507 citations screened were eligible, 28 of which had sufficient data for meta-analysis. The 28 studies enrolled 22, 114 children in 13 countries across sub-Saharan Africa, Southeast Asia and South America. Overall, the pooled estimates showed a prevalence of Plasmodium-helminth co-infections of 17.7% (95% CI 12.7–23.2%). Summary estimates from 14 studies showed a lower odds of P. falciparum infection in children co-infected with Schistosoma spp (OR: 0.65; 95%CI: 0.37–1.16). Similar lower odds of P. falciparum infection were observed from the summary estimates of 24 studies in children co-infected with soil transmitted helminths (STH) (OR: 0.42; 95%CI: 0.28–0.64). When adjusted for age, gender, socio-economic status, nutritional status and geographic location of the children, the risk of P. falciparum infection in children co-infected with STH was higher compared with children who did not have STH infection (OR = 1.3; 95% CI 1.03–1.65). A subset of 16 studies showed that the odds of anaemia were higher in children co-infected with Plasmodium and STH than in children with Plasmodium infection alone (OR = 1.20; 95% CI: 0.59–2.45), and were almost equal in children co-infected with Plasmodium-Schistosoma spp or Plasmodium infection alone (OR = 0.97, 95% CI: 0.30–3.14). Conclusions/Significance The current review suggests that prevalence of malaria-helminth co-infection is high in children living in endemic countries. The nature of the interactions between malaria and helminth infection and the impact of the co-infection on anaemia remain inconclusive and may be modulated by the immune responses of the affected children.

Background Physical activity is crucial to preventing noncommunicable diseases. This study aimed to provide up-to-date evidence on the epidemiology of insufficient physical activity across Nigeria to increase awareness and prompt relevant policy and public health response. Methods A systematic literature search of community-based studies on physical inactivity was conducted. We constructed a meta-regression epidemiologic model to determine the age-adjusted prevalence and number of physically inactive persons in Nigeria for 1995 and 2020. Results Fifteen studies covering a population of 13 814 adults met our selection criteria. The pooled crude prevalence of physically inactive persons in Nigeria was 52.0% (95% CI: 33.7–70.4), with prevalence in women higher at 55.8% (95% CI: 29.4–82.3) compared to men at 49.3% (95% CI: 24.7–73.9). Across settings, prevalence of physically inactive persons was significantly higher among urban dwellers (56.8%, 35.3–78.4) compared to rural dwellers (18.9%, 11.9–49.8). Among persons aged 20–79 years, the total number of physically inactive persons increased from 14.4 million to 48.6 million between 1995 and 2020, equivalent to a 240% increase over the 25-year period. Conclusions A comprehensive and robust strategy that addresses occupational policies, town planning, awareness and information, and sociocultural and contextual issues is crucial to improving physical activity levels in Nigeria.

Background Hypertension is the most common cardiovascular disease in Nigeria and contributes to a large non-communicable disease burden. Our aim was to implement and evaluate a large-scale hypertension treatment and control program, adapted from the Kaiser Permanent Northern California and World Health Organization HEARTS models, within public primary healthcare centers in the Federal Capital Territory, Nigeria. Methods A type 2 hybrid, interrupted time series design was used to generate novel information on large-scale implementation and effectiveness of a multi-level hypertension control program within 60 primary healthcare centers in the Federal Capital Territory, Nigeria. During the formative phase, baseline qualitative assessments were held with patients, health workers, and administrators to inform implementation package adaptation. The package includes a hypertension patient registry with empanelment, performance and quality reporting, simplified treatment guideline emphasizing fixed-dose combination therapy, reliable access to quality essential medicines and technology, team-based care, and health coaching and home blood pressure monitoring. Strategies to implement and adapt the package were identified based on barriers and facilitators mapped in the formative phase, previous implementation experience, mid-term qualitative evaluation, and ongoing stakeholder and site feedback. The control phase included 11 months of sequential registration of hypertensive patients at participating primary healthcare centers, followed by implementation of the remainder of the package components and evaluation over 37 subsequent, consecutive months of the intervention phase. The formative phase was completed between April 2019 and August 2019, followed by initiation of the control phase in January 2020. The control phase included 11 months (January 2020 to November 2020) of sequential registration and empanelment of hypertensive patients at participating primary healthcare centers. After completion of the control phase in November 2020, the intervention phase commenced in December 2020 and will be completed in December 2023. Discussion This trial will provide robust evidence for implementation and effectiveness of a multi-level implementation package more broadly throughout the Federal Capital Territory, which may inform hypertension systems of care throughout Nigeria and in other low- and middle-income countries. Implementation outcome results will be important to understand what system-, site-, personnel-, and patient-level factors are necessary for successful implementation of this intervention. Trial registration ClinicalTrials.gov NCT04158154. The trial was prospectively registered on November 8, 2019.