The Effectiveness of Infection Control Practices among Health Care Workers Responding to the COVID-19 Pandemic in Nigeria

Background: The world is currently experiencing a healthcare crisis caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Healthcare workers (HCWs) are at the forefront of controlling the spread of the disease;this response has resulted in a huge number of infections amongst HCWs and unfortunately some casualties. Infection prevention and control practices (IPC) are practical, proven methods that prevent avoidable harm to patients and protect health workers from contagious infection. This study was done to evaluate the effectiveness of IPC practices utilized in COVID-19 testing drive through facility in Lagos Nigeria. Method: The facility recruited 42 HCWs who were trained on IPC and use of Personal Protective Equipment (PPEs). Training on donning and doffing of PPEs, preparation of decontaminants and sample handling were done for relevant personnel. A daily log for monitoring COVID-19 symptoms was deployed to all HCWs;to help early detection of COVID-19 infection and prevent transmission amongst staff. Results: Of 42 personnel, 92.8% had a tertiary level of education while 71.4% had at least 5 years work experience. A total of 5 (11.9%) out of 42 HCWs were positive by week six of the study. All infected persons worked at the drive through centre. Most common symptom filled in the daily log tool was headache and fatigue. Conclusion: Despite all the measures introduced, 11.9% of HCWs became positive within 6 weeks, showing the highly infectious nature of the virus and the need to research into more effective measures in preventing the transmission of highly infectious pathogens to HCWs during outbreaks.

Morbidity and mortality outcomes of COVID-19 patients with and without hypertension in Lagos,Nigeria:a retrospective cohort study

Background:The current pandemic of coronavirus disease(COVID-19)caused by the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)has shown epidemiological and clinical characteristics that appear worsened in hypertensive patients.The morbidity and mortality of the disease among hypertensive patients in Africa have yet to be well described.Methods:In this retrospective cohort study all confirmed COVID-19 adult patients(≥18 years of age)in Lagos between February 27 to July 62,020 were included.Demographic,clinical and outcome data were extracted from electronic medical records of patients admitted at the COVID-19 isolation centers in Lagos.Outcomes included dying,being discharged after recovery or being evacuated/transferred.Descriptive statistics considered proportions,means and medians.The Chi-square and Fisher’s exact tests were used in determining associations between variables.Kaplan–Meier survival analysis and Cox regression were performed to quantify the risk of worse outcomes among hypertensives with COVID-19 and adjust for confounders.P-value≤0.05 was considered statistically significant.Results:A total of 2075 adults with COVID-19 were included in this study.The prevalence of hypertension,the most common comorbidity,was 17.8%followed by diabetes(7.2%)and asthma(2.0%).Overall mortality was 4.2%while mortality among the hypertensives was 13.7%.Severe symptoms and mortality were significantly higher among the hypertensives and survival rates were significantly lowered by the presence of additional comorbidity to 50%from 91%for those with hypertension alone and from 98%for all other patients(P<0.001).After adjustment for confounders(age and sex),severe COVID-19and death were higher for hypertensives{severe/critical illness:HR=2.41,P=0.001,95%CI=1.4–4.0,death:HR=2.30,P=0.001,95%CI=1.2–4.6,for those with hypertension only}{severe/critical illness:HR=3.76,P=0.001,95%CI=2.1–6.4,death:crude HR=6.63,P=0.001,95%CI=3.4–1.6,for those with additional comorbidities}.Hypertension posed an increased risk of severe morbidity(approx.4-fold)and death(approx.7-fold)from COVID-19 in the presence of multiple comorbidities.Conclusion:The potential morbidity and mortality risks of hypertension especially with other comorbidities in COVID-19 could help direct efforts towards prevention and prognostication.This provides the rationale for improving preventive caution for people with hypertension and other comorbidities and prioritizing them for future antiviral interventions.

Correction to:Morbidity and mortality outcomes of COVID-19 patients with and without hypertension in Lagos,Nigeria:a retrospective cohort study

Correction to:Global Health Research and Policy(2021)6:26 https://doi.org/10.1186/s41256-021-00210-6 Following publication of the original article[1],it is reported the second paragraph of the introduction includes some errors,as is indicated below.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Coinfection with Malaria in Selected States in Nigeria

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and Plasmodium species are the causative agents of coronavirus disease 2019 (COVID-19) and malaria respectively with similar clinical presentations. The objective of this study is to determine the burden of co-infection of SARS-CoV-2 and malaria in the general population. Five (5 mLs) of blood samples were collected for SARS-CoV-2 and malaria parasite test. The malaria test was performed using a commercially available one-step malaria antigen Plasmodium falciparum histidine-rich protein 2 (Pf HRP-II) rapid test kit. The results of the study showed that the participants that were coinfected with SARS-CoV-2 IgG and malaria were 13 (2.5%) in Lagos, 1114 (39.1%) in Delta and 49 (2.3%) in Sokoto States. The prevalence of coinfection of SARS-CoV-2 and malaria in urban areas in Lagos, Delta and Sokoto States were 7 (2.2%), 1373 (48.1%), and 5 (0.2%) respectively. In rural areas, the prevalence of coinfection of SARS-CoV-2 and malaria in Lagos, Delta and Sokoto States were 6 (0.3%), 365 (12.8%), and 44 (2.1%) respectively in this study. This suggests that participants in the urban areas were more prone to co-infections than the rural areas in Lagos and Delta states, while it was otherwise in Sokoto State. In conclusion, the co-infection of SARS-CoV-2 and malaria was very high in Delta State compared to the other States. It is important for clinics to screen for both diseases when patients present with symptoms of malaria. This is because the infections have similar symptoms and the public is quick to assume malaria infection without diagnosing for COVID-19 and vice versa.

Factors Affecting Treatment Interruption among TB Patients in Lagos Nigeria: Is There Any Need for Treatment Supporters?

Background: This study assessed treatment interruption of tuberculosis (TB) patients managed by treatment supporters and health care workers and other predictors of treatment interruption. Methods: A descriptive cross-sectional study was conducted. Four hundred and seventy new smear positive TB patients above 14 years of age were consecutively recruited between October 1 and December 31 2012 from 34 (23 public and 11 private) directly observed treatment short course (DOTS) facilities that offered TB treatment and microscopy services. They were followed up till treatment was completed. Logistic regression was used to assess the predictors of treatment interruption. Results: A significantly higher proportion of smokers (58.6% vs 38.3%, p = 0.030), patients supervised by treatment supporters (44.4% vs 34.7%, p = 0.032), patients not counselled before initiation of treatment (55.6% vs 38.2%, p = 0.041), patients managed at private DOTS facilities (50% vs 36.3%, p = 0.010) and TB/HIV co-infected patients (54.2% vs 38.6%, p = 0.038) had treatment interruption. Predictors of treatment interruption were supervision by treatment supporters, smoking, lack of pre-treatment counselling and TB/HIV co-infection. Conclusion: A higher proportion of patients supervised by treatment supporters had treatment interruption than those supervised by health care workers. There may be a need to review the concept of treatment supervision by treatment supporters in Lagos state Nigeria.

Investigating catastrophic health expenditure among people living with HIV and AIDS in South Western Nigeria

Background:This study aimed to determine the catastrophic healthcare expenditure(CHE)among people living with HIV(PLHIV)in Lagos and to identify factors associated with CHE among them.Methods:The study was a descriptive cross-sectional survey conducted between January and March 2021 among 578 PLHIVs drawn from various healthcare facilities in Lagos where HIV care and treatment services should be provided free of charge.Data were collected through pretested questionnaires and analyzed using Stata SE 12.Results:The mean monthly expenditure on food was N29,282($53.2),while expenditure on healthcare averaged N8364($15.2).Nearly 60%of respondents experienced CHE,while around 30%had to borrow money to pay for some aspect of their medical treatment.Almost all(96%)had no health insurance plan.Respondents'group,personal income,perception of current health status,and the number of people in their households were significantly associated with catastrophic health expenditure p<0.05.PLHIV in the racial/ethnic minority/migrants'group and those who earned less than₦30,000($55)were statistically significantly associated with CHE at p<0.001 with OR of 28.7 and 3.15,respectively.Conclusions:The study,therefore,highlights the widespread financial hardship faced by PLHIV in accessing healthcare,and the need for policies to increase financial risk protection.