BackgroundWith reports of surges in COVID-19 case numbers across over 50 countries, country-level epidemiological analysis is required to inform context-appropriate response strategies for containment and mitigation of the outbreak. We aimed to compare the epidemiological features of the first and second waves of COVID-19 in Nigeria.MethodsWe conducted a retrospective analysis of the Surveillance Outbreak Response Management and Analysis System data of the first and second epidemiological waves, which were between 27 February and 24 October 2020, and 25 October 2020 to 3 April 2021, respectively. Descriptive statistical measures including frequencies and percentages, test positivity rate (TPR), cumulative incidence (CI) and case fatality rates (CFRs) were compared. A p value of <0.05 was considered statistically significant. All statistical analyses were carried out in STATA V.13.ResultsThere were 802 143 tests recorded during the study period (362 550 and 439 593 in the first and second waves, respectively). Of these, 66 121 (18.2%) and 91 644 (20.8%) tested positive in the first and second waves, respectively. There was a 21.3% increase in the number of tests conducted in the second wave with TPR increasing by 14.3%. CI during the first and second waves were 30.3/100 000 and 42.0/100 000 respectively. During the second wave, confirmed COVID-19 cases increased among females and people 30 years old or younger and decreased among urban residents and individuals with travel history within 14 days of sample collection (p value <0.001). Most confirmed cases were asymptomatic at diagnosis during both waves: 74.9% in the first wave; 79.7% in the second wave. CFR decreased during the second wave (0.7%) compared with the first wave (1.8%).ConclusionNigeria experienced a larger but less severe second wave of COVID-19. Continued implementation of public health and social measures is needed to mitigate the resurgence of another wave.
COVID-19 mortality rate has not been formally assessed in Nigeria. Thus, we aimed to address this gap and identify associated mortality risk factors during the first and second waves in Nigeria. This was a retrospective analysis of national surveillance data from all 37 States in Nigeria between February 27, 2020, and April 3, 2021. The outcome variable was mortality amongst persons who tested positive for SARS-CoV-2 by Reverse-Transcriptase Polymerase Chain Reaction. Incidence rates of COVID-19 mortality was calculated by dividing the number of deaths by total person-time (in days) contributed by the entire study population and presented per 100,000 person-days with 95% Confidence Intervals (95% CI). Adjusted negative binomial regression was used to identify factors associated with COVID-19 mortality. Findings are presented as adjusted Incidence Rate Ratios (aIRR) with 95% CI. The first wave included 65,790 COVID-19 patients, of whom 994 (1∙51%) died; the second wave included 91,089 patients, of whom 513 (0∙56%) died. The incidence rate of COVID-19 mortality was higher in the first wave [54∙25 (95% CI: 50∙98–57∙73)] than in the second wave [19∙19 (17∙60–20∙93)]. Factors independently associated with increased risk of COVID-19 mortality in both waves were: age ≥45 years, male gender [first wave aIRR 1∙65 (1∙35–2∙02) and second wave 1∙52 (1∙11–2∙06)], being symptomatic [aIRR 3∙17 (2∙59–3∙89) and 3∙04 (2∙20–4∙21)], and being hospitalised [aIRR 4∙19 (3∙26–5∙39) and 7∙84 (4∙90–12∙54)]. Relative to South-West, residency in the South-South and North-West was associated with an increased risk of COVID-19 mortality in both waves. In conclusion, the rate of COVID-19 mortality in Nigeria was higher in the first wave than in the second wave, suggesting an improvement in public health response and clinical care in the second wave. However, this needs to be interpreted with caution given the inherent limitations of the country’s surveillance system during the study.
Background Limited healthcare facility (HCF) resources and capacity to implement multi-stranded cholera interventions (water, sanitation, and hygiene (WASH), surveillance, case management, and community engagement) can hinder the actualisation of the global strategic roadmap goals for cholera control, especially in settings made fragile by armed conflicts, such as the north-east region of Nigeria. Therefore, we aimed to assess HCF resource availability and capacity to implement these cholera interventions in Adamawa and Bauchi States in Nigeria as well as assess their coordination in both states and Abuja where national coordination of cholera is based. Methods We conducted a cross-sectional survey using a face-to-face structured questionnaire to collect data on multi-stranded cholera interventions and their respective indicators in HCFs. We generated scores to describe the resource availability of each cholera intervention and categorised them as follows: 0–50 (low), 51–70 (moderate), 71–90 (high), and over 90 (excellent). Further, we defined an HCF with a high capacity to implement a cholera intervention as one with a score equal to or above the average intervention score. Results One hundred and twenty HCFs (55 in Adamawa and 65 in Bauchi) were surveyed in March 2021, most of which were primary healthcare centres (83%; 99/120). In both states, resource availability for WASH indicators had high to excellent median scores; surveillance and community engagement indicators had low median scores. Median resource availability scores for case management indicators ranged from low to moderate. Coordination of cholera interventions in Adamawa State and Abuja was high but low in Bauchi State. Overall, HCF capacity to implement multi-stranded cholera interventions was high, though higher in Adamawa State than in Bauchi State. Conclusions The study found a marked variation in HCF resource availability and capacity within locations and by cholera interventions and identified cholera interventions that should be prioritised for strengthening as surveillance and laboratory, case management, and community engagement. The findings support adopting a differential approach to strengthening cholera interventions for better preparedness and response to cholera outbreaks.
Although the true burden and the factors responsible for Buruli ulcer (BU) occurrence in Nigeria is not yet known, the disease has become an issue of great concern in some parts of the country, especially in Anambra State. It is against this background that this study analyzed the prevalence of BU in Anambra North with the objectives of determining the hotspots, trends and factors influencing the occurrence of the disease in the study area. Three LGAs and fifteen communities were selected based on purposive sampling in which 400 copies of questionnaire were randomly distributed. Field survey, topographic map of the study area, administrative map of the study area, Global Position System (GPS) and Google earth satellite images were the materials and methods used for the study. The analysis was done using ArcGIS 10.1 and Excel software packages. The results show a variation in the temporal distribution of the disease. The trend analysis revealed that the months of February and May recorded the highest number of cases of BU (17.2%) and (15.6%), respectively while the months of September and October recorded no case of the disease. The study also discovered five significant hotspots of BU at 95% confidence level using the Getis-Ord G * tool. The hotspots of BU in the study area include Omor (p-value: 0.0119), Umumbo (0.0119), Igbakwu (p-value: 0.0119), Anaku (p-value: 0.0197) and Umuerum (p-value: 0.0197). On the factors influencing BU occurrence in the study area, cultural practices, farming/fishing on swampy lands, swimming in rivers and living close to stagnant bodies of water were identified as risk factors of BU occurrence in the study area. The bivariate analysis of BU factors revealed that cultural practices pose the highest risk of BU occurrence with a percentage increase in risk of 846% while wearing of protective gadgets reduces the risk of the disease with a percentage decrease in risk of 20%. More so, the study showed that the disease has negative effects on the feeding habit and employment of majority (76.6%) and (78.1%) respectively of the affected persons. The study therefore concludes by recommending that people should be discouraged from activities around the ox-bow lakes such as swimming and dipping legs in pond waters.
Background Infection prevention and control (IPC) activities play a large role in preventing the transmission of SARS-CoV-2 in healthcare settings. This study describes the state of IPC preparedness within health facilities in Nigeria during the early phase of coronavirus disease (COVID-19) pandemic. Methods We carried out a cross sectional study of health facilities across Nigeria using a COVID-19 IPC checklist adapted from the U.S Centers for Disease Control and Prevention. The IPC aspects assessed were the existence of IPC committee and teams with terms of reference and workplans, IPC training, availability of personal protective equipment and having systems in place for screening, isolation and notification of COVID-19 patients. Existence of the assessed aspects was regarded as preparedness in that aspect. Results In total, 461 health facilities comprising, 350 (75.9%) private and 111 (24.1%) public health facilities participated. Only 19 (4.1%) health facilities were COVID-19 treatment centres with 68% of these being public health facilities. Public health facilities were better prepared in the areas of IPC programme with 69.7% of them having an IPC focal point versus 32.3% of private facilities. More public facilities (59.6%) had an IPC workplan versus 26.8% of private facilities. Neither the public nor the private facilities were adequately prepared for triaging, screening, and notifying suspected cases, as well as having trained staff and equipment to implement triaging. Conclusions The results highlight the need for government, organisations and policymakers to establish conducive IPC structures to reduce the risk of COVID-19 transmission in healthcare settings.
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