ObjectivesNigeria reported an upsurge in cholera cases in October 2020, which then transitioned into a large, disseminated epidemic for most of 2021. This study aimed to describe the epidemiology, diagnostic performance of rapid diagnostic test (RDT) kits and the factors associated with mortality during the epidemic.DesignA retrospective analysis of national surveillance data.Setting33 of 37 states (including the Federal Capital Territory) in Nigeria.ParticipantsPersons who met cholera case definition (a person of any age with acute watery diarrhoea, with or without vomiting) between October 2020 and October 2021 within the Nigeria Centre for Disease Control surveillance data.Outcome measuresAttack rate (AR; per 100 000 persons), case fatality rate (CFR; %) and accuracy of RDT performance compared with culture using area under the receiver operating characteristic curve (AUROC). Additionally, individual factors associated with cholera deaths and hospitalisation were presented as adjusted OR with 95% CIs.ResultsOverall, 93 598 cholera cases and 3298 deaths (CFR: 3.5%) were reported across 33 of 37 states in Nigeria within the study period. The proportions of cholera cases were higher in men aged 5–14 years and women aged 25–44 years. The overall AR was 46.5 per 100 000 persons. The North-West region recorded the highest AR with 102 per 100 000. Older age, male gender, residency in the North-Central region and severe dehydration significantly increased the odds of cholera deaths. The cholera RDT had excellent diagnostic accuracy (AUROC=0.91; 95% CI 0.87 to 0.96).ConclusionsCholera remains a serious public health threat in Nigeria with a high mortality rate. Thus, we recommend making RDT kits more widely accessible for improved surveillance and prompt case management across the country.

Background: Nocardiosis is a clinical and diagnostic challenge, compounded by lacunae in existing literature. Our objectives were to establish the clinical spectrum of this disease in our setting, describe the most common causative agent of the disease and to ascertain differences in our patient population from available data.Methods & Materials: This was a 10 year (2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013) retrospective study carried out at a tertiary care centre in South India, of 131 cases of nocardiosis. The electronic medical records were studied and data analysed.Results: Sixty three percent were male, 23% of all in the sixth decade of life. The most common sites of infection were the skin and the eye -36 (27%) patients each and the lower respiratory tract -35 patients(26%). 48 (37%) patients were on immunosuppressant therapy, either a triple drug therapy following renal transplant, autoimmune disorders/ haematological malignancies on combination immunosuppressants or patients on prolonged corticosteroids. Of 36 patients with nocardiosis of the eye, 30 (83%) were corneal ulcers with history of trauma with vegetative matter or soil, and 5(14%) were endophthalmitis following intraocular lens implantation. 16(46%) patients with respiratory tract nocardiosis had a previous lung pathology. 11(8%) were HIV associated nocardiosis. Disseminated disease was seen in 7(5.3%) patients following renal transplant and in 3(2.3%) patients with SLE, all on triple drug immunosuppression. The most common organism isolated was Nocardia asteroides in 73(56%), followed by Nocardia spp in 32(24%), aerobic actinomycetes in 24(18%) and Nocardia brasiliensis in 2(1.5%). All patients responded to treatment with cotrimoxazole alone or in addition to surgical debridement for cutaneous and subcutaneous lesions. There was only one Nocardiosis related death in this cohort of patients. Antimicrobial susceptibility testing performed on 72 isolates showed 6.9% , 9.7%, 31%, 38%, 75%, 42%, 31%, 74% susceptibility to penicillin, ampicillin, erythromycin, tetracycline, cotrimoxazole, chloramphenicol, cefazolin and triple sulfa respectively.Conclusion: We report a predominance of nocardiosis from the eye and nocardiosis following immunosuppression. The most common species isolated was N.asteroides. A paucity in HIV associated nocardiosis is striking. Antimicrobial susceptibility showed 75% susceptibility to cotrimoxazole, the drug of choice, which was reflected by a good response to therapy in this cohort. http://dx.

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Background Over the years, Nigeria has used District Vaccine Data Management Tool (DVDMT) for surveillance data collection including routine immunization. In 2012, Nigeria adopted District Health Information Software (DHIS2), a Java driving online real-time tool for data collection. In 2015, Enugu State commenced the use of DHIS2 alongside the traditional DVDMT as surveillance data capturing tools. Objective The objective was to carry out an evaluation of the two surveillance data tools to assess surveillance attributes, interoperability, effect in decision making, and preference of use. Methods We quantitatively and qualitatively assessed surveillance attributes of Enugu State’s DHIS2 and DVDMT from 2015 to 2018 using adapted CDC guidelines (2001). We administered semi-structured questionnaires to all 17 local immunization officers from the 17 local government areas (districts) to assess surveillance attributes. We carried out desk review at all levels, key informants done with 6 purposefully selected stakeholders, and focused group discussion carried out with 6 randomly selected heads of surveillance at local governments areas. We recorded proportions, interoperability, effect in decision making, and preference of use. Results Average completeness of data is 100% in both DHIS2 and DVDMT systems (target 90%). Eligibility is 100% in DHIS2 and 85% in DVDMT (target 80%). Timeliness of reporting is 100% and 80% in DHIS2 and DVDMT, respectively (target 80%). All stakeholders accepted both tools and agreed that they are simple and flexible. In addition to collection of all data recorded by DVDMT, DHIS2 captures vaccine utilization. Data collection and transmission of DVDMT and DHIS2 are carried out by the same surveillance personnel at health facility and local government area levels. Apart from vaccine utilization both tools can complement each other in case of missed data as they record the same thing. All key informants opined that it is double work managing the two tools and also agreed that DHIS2 is better than DVDMT in decision making because it has features for data visualization and real-time reporting. The focused group discussion agreed that both tools are good, although DVDMT is easier to work with as DHIS2 requires computer proficiency of current users alongside hardware management of the Java-enabled phones used in data capture and transmission. However, they also agreed that DHIS2 usage is less time consuming and opined they will prefer to use DHIS2 as the only data capturing tool in Enugu State if proper capacity building is done. Conclusions The DHIS2 and DVDMT surveillance data tools in Enugu State is meeting all its targets based on surveillance attributes, though DHIS2 provides better quality data. There is a good understanding and synergy in operation of the two systems in all levels and intermittently data from both tools can be compared. DHIS2 can enable prompt decision making than DVDMT as data can be assessed and visualized in real time. Surveillance officers prefer the use of DHIS2 as the only surveillance tool in Enugu State, although proficiency is a challenge. We recommended a gradual phase out of DVDMT for data capturing in Enugu State, while capacity building of users for DHIS2 should be addressed.

Introduction event-based surveillance (EBS) is a surveillance method involving systematic and prompt data collection on incidents of public health importance, and complements the current indicator-based surveillance system and the Integrated Disease Surveillance and Response System (IDSR). It also promotes a rapid assessment and response to public health emergencies in Nigeria, although there is a lack of information regarding the status of EBS among Public Health Stakeholders in Nigeria; hence our study aimed to assess the awareness, availability, and utility of EBS among Nigerian public health stakeholders. Methods we conducted a cross-sectional study to assess the awareness, availability, functionality, and utilization of EBS in the 36 States in Nigeria, plus the Federal Capital Territory (FCT). We interviewed 53 stakeholders in disease surveillance and response using a self-administered, semi-structured questionnaire to obtain responses on the awareness of the event-based surveillance system, availability, and functionality. We also assessed the common structures used to report health-related events and the availability of minimum requirements for an event-based surveillance system. We performed descriptive statistics for the data obtained. Results the majority of respondents were males and 37.7% were disease surveillance and notification officers (DSNOs). Awareness of EBS was poor with about half, 49% of the respondents reported hearing of EBS, but only 17% described it correctly. The overall level of availability of the EBS reporting structure was inadequate, 28.2% and poorly utilised in the States. Conclusion the awareness, availability, and utilization of event-based surveillance systems are low in Nigeria. The government should improve the feasibility and utility of EBS in the States to enhance early disease detection and response.