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The risk factors predisposing children to ascariasis transmission in a rural community of Osun State, Nigeria were investigated from November 2005 to April 2006. Children below 16 years of age were examined at the household level after information on biodata, access to water supply and sanitation, socio-economic status of their parents and degree of cohabitation with their parents was collected using a questionnaire. Of 440 children examined, overall prevalence was 60% and median intensity was 1548 eggs per gram (epg) (min. 48 epg; max. 55464 epg). Infection patterns were gender comparable and age dependent, with peak prevalence (67.8%) occurring in children aged 5-9 years and peak median intensity (4368 epg) in children aged >or=15 years. Logistic regression analysis revealed that prevalence was influenced by patterns of water supply and sanitation, parents' educational background, number of biological parents living with a child and number of playmates a child has. These findings suggest that socio-environmental risk factors which play a role in disease transmission need to be taken into account when formulating sustainable control strategies for ascariasis and other intestinal parasites in Nigeria and elsewhere.

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Background Described as the ‘backbone of health systems’, particularly in low- and middle-income countries, community health workers (CHWs) are a critical cadre on the frontline of any outbreak response. However, it is widely recognised that CHWs are frequently lacking in appropriate support from the health system due to inadequate physical, social and financial resources. Furthermore, despite their critical role in service delivery, the health and well-being of CHWs is seldom considered and the additional emotional and physical burdens that health systems shocks can present are frequently ignored. Thus a critical step in strengthening health systems to manage disease outbreaks or other system shocks is to ensure that CHWs are adequately supported. Within this study we document the experiences of CHWs within Nigeria during the coronavirus disease 2019 (COVID-19) outbreak to understand the impact of the pandemic on CHW well-being with a view to identifying strategies that could support CHWs during COVID-19 and subsequent health system shocks. Methods This study was based in Ogun, Kaduna and Kwara States, Nigeria. We used the creative participatory methodology of photovoice with 30 CHWs (10 in each state). Participants were asked to take photos documenting their experiences of working and living through the pandemic. Participants sent photos with captions to the research team via WhatsApp following one-on-one discussions. Photos were co-analysed among participants in focus group discussions using thematic analysis. Results Our findings reveal similar experiences of CHWs across Ogun, Kwara and Kaduna States in Nigeria, providing a unique insight into how the Nigerian health system was impacted and how this closely aligns to the performance and well-being of CHWs. CHW experiences related to three overarching themes: major stressors and challenges experienced due to COVID-19 (fear of contracting COVID-19, food insecurity, personal and gendered impacts), the impact of COVID-19 on providing routine care (stigma from community members, heavy workloads and inadequate equipment provision) and motivation and support from the community (pride in their roles and valued support from community leaders). The challenges highlighted through photovoice led to developing recommendations to address some of the challenges. This included training, adequate resource provision, routine supervision and peer support. Conclusions COVID-19 highlighted the burden health workers often face. Photovoice allowed a space for frontline health workers to come together to share common experiences, particularly the psychosocial impact of working during health system shocks and its impact on performance. This underlines the need to acknowledge mental health and prioritise the well-being of healthcare staff. Sharing stories from the perspectives of health workers provides a platform to share learning and strategies on how to best support health workers holistically, particularly during health system shocks.