Enhancing Private Healthcare Effectiveness in Lagos State, Nigeria: An Overview of the Effect of Quality Improvement Initiatives and Implications for Sustainable Healthcare Delivery

Background: Nigeria, a nation grappling with rapid population growth, economic intricacies, and complex healthcare challenges, particularly in Lagos State, the economic hub and most populous state, faces the challenge of ensuring quality healthcare access. The overview of the effect of quality improvement initiatives in this paper focuses on private healthcare providers in Lagos State, Nigeria. The study assesses the impact of donor-funded quality improvement projects on these private healthcare facilities. It explores the level of participation, perceived support, and tangible effects of the initiatives on healthcare delivery within private healthcare facilities. It also examines how these initiatives influence patient inflow and facility ratings, and bring about additional benefits and improvements, provides insights into the challenges faced by private healthcare providers in implementing quality improvement projects and elicits recommendations for improving the effectiveness of such initiatives. Methods: Qualitative research design was employed for in-depth exploration, utilizing semi-structured interviews. Private healthcare providers in Lagos involved in the SP4FP Quality Improvement Project were purposively sampled for diversity. Face-to-face interviews elicited insights into participation, perceived support, and project effects. Questions covered participation levels, support perception, changes observed, challenges faced, and recommendations. Thematic analysis identified recurring themes from interview transcripts. Adherence to ethical guidelines ensured participant confidentiality and informed consent. Results: Respondents affirmed active involvement in the SP4FP Quality Improvement Project, echoing literature emphasizing private-sector collaboration with the public sector. While acknowledging positive influences on facility ratings, respondents highlighted challenges within the broader Nigerian healthcare landscape affecting patient numbers. Respondents cited tangible improvements, particularly in staff management and patient care processes, validating the positive influence of quality improvement projects. Financial constraints emerged as a significant challenge, aligning with existing literature emphasizing the pragmatic difficulties faced by private healthcare providers. Conclusions: This study illuminates the complex landscape of private healthcare provision in Lagos State, emphasizing the positive impact of donor-funded quality improvement projects. The findings provide nuanced insights, guiding policymakers, healthcare managers, and practitioners toward collaborative, sustainable improvements. As Nigeria progresses, these lessons will be crucial in shaping healthcare policies prioritizing population well-being.

Screening of Rodents from Rural Communities of Lagos and Ogun State Nigeria of Lassa Virus RNA

Background: In recent times, there has been an increase in the number of Lassa fever cases resulting from the several episodes of Lassa fever epidemics ravaging Nigeria and other West African countries. The presence of Lassa virus in rodents other than the major reservoir (Mastomys natalensis) has been a public health concern as to the actual burden of the disease. It is therefore of a public health necessity to explore the LASV RNA habouring potential of several species of rodents in endemic as well as non-endemic areas for proper prevention of emergence of outbreaks in non-endemic areas. Objectives: The aim of this study was to detect the presence of LASV RNA in different species of rodents in Ikorodu, Lagos state and Abeokuta, Ogun state. Methods: A total of ninety one (91) rodents were captured from Ikorodu, Lagos State (61 rodents) and Abeokuta, Ogun State (30 rodents), euthanized, bled, and plasma obtained for the detection of LASV RNA by Reverse Transcriptase Polymerase Chain Reaction. Results: A total of 91 rodents consisting of 77 Rattus rattus and 14 Crocidura spp. The S segment of LASV RNA was not in any of the 91 rodents’ plasma samples. Conclusion: The rodents captured within the rural communities of Ikorodu, Lagos State and Abeokuta, Ogun State were found not to habour the LASV RNA. This study is limited by the relatively small sample size. Similar studies should be encouraged both in endemic and non-endemic areas in order to understand the actual burden of Lassa fever as well as put into check future epidemics.

Comparative Analysis of the Factors Influencing Metro Passenger Arrival Volumes in Wuhan, China, and Lagos, Nigeria: An Application of Association Rule Mining and Neural Network Models

This study explores the factors influencing metro passengers’ arrival volume in Wuhan, China, and Lagos, Nigeria, by examining weather, time of day, waiting time, travel behavior, arrival patterns, and metro satisfaction. It addresses a significant research gap in understanding metro passengers’ dynamics across cultural and geographical contexts. It employs questionnaires, field observations, and advanced data analysis techniques like association rule mining and neural network modeling. Key findings include a correlation between rainy weather, shorter waiting times, and higher arrival volumes. Neural network models showed high predictive accuracy, with waiting time, metro satisfaction, and weather being significant factors in Lagos Light Rail Blue Line Metro. In contrast, arrival patterns, weather, and time of day were more influential in Wuhan Metro Line 5. Results suggest that improving metro satisfaction and reducing waiting times could increase arrival volumes in Lagos Metro while adjusting schedules for weather and peak times could optimize flow in Wuhan Metro. These insights are valuable for transportation planning, passenger arrival volume management, and enhancing user experiences, potentially benefiting urban transportation sustainability and development goals.

Lagos State Hospital Waste Management Practices: A Descriptive Overview with Stakeholders’ Role and Key Recommendations

Background: Waste generation and its disposal is an essential issue in the sustainability of the environment and the planet’s future. Waste management is essential across sectors, likewise the health sector. Therefore, there is a need to employ extra care and attention to handling waste generated from healthcare facilities to avoid the dangers of poor biomedical waste management. We carried out this study to examine the waste management practice in healthcare facilities in Lagos State. Methods: The study was a descriptive survey carried out in one-thousand two hundred and fifty-six (1256) healthcare facilities in Lagos State. Nine hundred sixty-nine (969) of these facilities are located in urban areas, while two hundred and eighty-seven (287) are rural. The facilities studied are government/public health facilities (15.45%), private-for-profit facilities (82.88%), NGOs, Mission/Faith-Based medical facilities (1.67%). The data collected were analyzed using descriptive statistics. Specifically, we utilized bar charts, frequency, and percentage. Result: The result shows that 98.4% (1236) of the studied facilities are registered with the Lagos State Waste Management Authority (LAWMA), while 1.6% (20) are not registered. 98.5% (191) of the 194 government-owned facilities, 98.5% (1025) of the 1041 private-for-profit facilities, and 98.2% (20) of the 21 NGOs/faith-based health facilities are registered with Lagos State Waste Management Authority. The result also shows that 94% of the healthcare facilities studied in Lagos State use color-coded waste bags to segregate waste at the point of origin. 58.7% of the facilities use red-colored bags, 33.3% use yellow-colored bags, 10.7% use black-colored bags, and 1.3% use brown biohazard bags for segregating Infectious waste. Also, 34.2% of the health facilities in Lagos state use red-colored bags, 36.9% use yellow-colored bags, 11% use black-colored bags, and 4.1% use brown-colored bags to segregate their hazardous waste. Conclusion: Some healthcare facilities in Lagos State do not follow the recommended guidelines for medical waste segregation. Waste generated is not appropriately segregated at the point of origin into the recommended colored bags/bins in some facilities. Thus, a policy and procedure regulating healthcare waste are mandatory. It is important to regularly train healthcare workers on proper waste management practices and encourage staff to read and apply WHO rules in managing healthcare waste. Healthcare personnel should realize that hazardous material is a potential cause of a public disaster.

The Place of Human Resource Management in Lagos State Healthcare Delivery: A Statistical Overview

Background: Behind every great system is an organized team;this is especially true in the healthcare industry, where a dedicated human resources team can effectively recruit employees, train staff, and implement safety measures in the workplace. The importance of human resources in the healthcare industry cannot be overstated, with benefits ranging from providing an orderly and effectively run facility to equipping staff with the most accurate and up-to-date training. Proper human resources management is critical in providing high-quality health care. A refocus on human resources management in healthcare requires more research to develop new policies. Effective human resources management strategies are greatly needed to achieve better outcomes and access to health care worldwide. Methods: This study leveraged NOI Polls census data on Health Facility Assessment for Lagos State. One thousand two hundred fifty-six health care facilities were assessed in Lagos State;numbers of Health workers were documented alongside their area of specialization. Also, demographic characterizations of the facilities, such as LGA, Ownership type, Facility Level Care, and Category of the facility, were also documented. Descriptive statistics alongside cross tabulation was done to present the various area of specialization of the health workers. Multiple response analysis was done to understand the distribution of human resources across the health facilities. At the same time, Chi-square and correlation tests were conducted to test the independence of various categories recorded while understanding the relationships among selected specialties. Results: The study revealed that Nurses were the most common health specialist in the Lagos State health facilities. At the same time, Gynecologists and General surgeons are the two medical specialists mostly common in health facilities. Midwives are the second most common health specialist working full time, while Generalist medical doctors make up the top three health specialists working full time. Nurses and Midwives had the highest number in Lagos State, while Pulmonologists were currently the lowest human resource available in Lagos State health care system. It was also noted that health facility distribution across Lagos’s urban and rural areas was even. In contrast, distribution based on other factors such as ownership type, Facility level of care, and facility category was slightly skewed. Conclusion: The distribution of health workers in health facility across LGA in Lagos State depend on Ownership type, Facility level of care, and category of the facility.

基于集对分析的Lagos地区轨道交通线路方案研究

研究目的:近年来,中非之间的交通项目合作交流日益频繁。作为尼日利亚第一大城市,Lagos的经济整体水平近年来有了明显的提升,随着日益增长的客货运需求,轨道交通已经成为该地区城市交通规划的重点。本文旨在提出合适的线路方案,并针对Lagos地区轨道交通线路方案分析具有不确定、多属性的特点,采用合适的评价方法从众多可行路线方案中选取最优方案。研究结果:集对分析理论是一种新的处理不确定性多属性问题的评价方法,通过对不确定系统的定量分析,对不同方案的不确定性进行排序,从而得到最稳定的方案,即最优方案。本文首先采用集对分析理论建立了Lagos地区轨道交通线路综合评价模型,其次运用层次分析法确定指标权重,最后构建评价指标体系对多个备选方案进行评价,得到了最优方案。结果表明集对分析理论可用于轨道交通线路方案优选。集对分析;Lagos;轨道交通;线路方案;

Assessment of the Effects of Temperature, Precipitation and Altitude on Greenhouse Gas Emission from Soils in Lagos Metropolis

Significant pool of carbon is present in the biosphere as soil organic carbon (SOC). More carbon is stored in the soils which include peatlands, wetlands and permafrost than is present in the atmosphere. There are still controversies regarding the effects of climate change on global soil carbon stocks. This study seeks to: assess the effect of altitude, temperature and precipitation on the greenhouse gas emission from soil;and to examine the correlation between soil organic carbon and soil texture. With a total of 81 samples collected at 3 different depths (0 - 10 cm, 10 - 20 cm, 20 - 30 cm) from 27 locations in different regions of Lagos, the relation of soil organic carbon concentration to climate was investigated. Samples taken were analyzed for soil organic matter, soil organic carbon (SOC), and percentage of silt/clay/sand. The amount of carbon dioxide released was calculated. Temperature, precipitation and altitude were also taken into consideration. From the 27 locations topsoil had 8 locations of highest SOC contents;middle soil had 2 locations of highest SOC contents while bottom soil had 17 locations of highest SOC contents. SOC contents of top soil were linked with soil texture, vegetation type, temperature, precipitation, and altitude. The study showed that SOC increased with decrease in temperature, decrease in precipitation, and increase in altitude. Forest, shrubs and grassland types of vegetation, as well as soil depths also favour SOC contents. The study also showed that increase in temperature and altitude favours greenhouse gas emission from the soil. From our findings, SOC and climate change are greatly linked.

Granulometric and Sedimentologic Study of Beach Sediments, Lagos, Southwestern Nigeria

Grain size analysis and sedimentology of beach sediments in Lagos, southwestern Nigeria have been studied. Ten fresh beach sediment samples were randomly collected at a depth of 25 cm - 40 cm along Lagos and Badagry axis. The sediments were analyzed by wet sieving method. Ternary diagrams indicate that the beach sediment is silty. The graphic mean ranges from 1.02ф (medium grained) to 2.21ф (fine grained) with an average of 1.61ф (medium grained). The preponderance of medium grained sediments and lack of coarse sands suggest moderate to high energy conditions of deposition. Graphic standard deviation ranges from 0.01ф - 0.81ф (very well sorted to moderately well sorted), with an average of 0.52ф (moderately well sorted). This is probably due to rapid back and forth flow of the depositing medium. Inclusive graphic skewness ranges from -0.38 to 1.41 (strongly coarse skewed to strongly fine skewed), with an average of 0.41 (strongly fine skewed). The graphic kurtosis values are between 0.44 and 1.37, which indicates very platykurtic to leptokurtic;with an average of 0.78 (platykurtic). This variation suggests that part of the sediment achieved its sorting elsewhere in high-energy environment. Histograms of the sediments exhibit both unimodal and bimodal trends. The arrangement is dominantly asymmetrical with varying modal class, which could be attributed to variation in the energy of the transporting medium. Bivariate plots (simple skewness vs. standard deviation and mean size vs. standard deviation) show the samples plotting mainly in the river sand zone, which suggests that the sediments were initially river sediments before reworking to the present site;other parameters that discriminate between river channel deposits, overbank deposits and overbank-pool deposits show the beach sediments plotting in the river channel zone. Linear discriminant functions analysis indicates a shallow marine beach environment in agitated water, with inputs from aeolian source. The Passega C-M diagram suggests suspension and rolling as the mode of deposition.

尼铁现代化项目Lagos至Ibadan段建设方案探讨

根据尼日利亚铁路现代化项目Lagos至Kano线Lagos至Ibadan段的功能定位,对项目建设标准、线路走向、投资效益等进行系统研究,提出建设方案的思路、对策。本项目研究了6‰、12‰、15‰三个限制坡度方案,经综合比选,推荐12‰限制坡度方案。从工程经济性、与城市规划发展适应性、项目可实施性等方面对线位方案进行综合比选。本项目的建设对沿线经济发展,改善交通基础服务水平,推进尼日利亚铁路现代化建设具有重大意义。

拉各斯(lagos)轻轨建筑设计研究

介绍Lagos轻轨项目背景及工程情况,该种线路敷设方式以地面为主的轻轨在国内尚不多见,探讨了各车站如何完善城市功能、整合周边环境及提升城市形象。重点分析了各种站型的优缺点、各种交通体系间的换乘关系、客流的组织（特别是大型集中性客流的）及车站设计情况,最后对海外铁路项目设计中的技术问题做了总结。

A Framework for Potable Water in the Face of Plenty for Sustainability on Lekki Peninsula of Lagos State, Nigeria

Peninsulas are exceptional areas loved to be developed uniquely in most part of the globe. Lekki Peninsulas in Lagos, Nigeria is fast growing, benefitting from similar fortunes such as modern residential suburbs, free trade zone, airport;and tourism are springing up but without adequate potable water for sustainable development. Reconnaissance surveys followed by an In-Depth-Interview were carried out. The commonest sources are sachet, bottled and borehole waters. Sachet and bottled waters are readily available but at unaffordable costs. The most frequently available is borehole, but chemical, physical/organoleptic and microbiological analysis show that the compositions are not within WHO permissible standards. Sustainability is in jeopardy. Individuals, organizations and businesses spend average of 15% of their income on treatments to meet acceptable standards. There are needs to bridge the gap between the residents taking untreated poor water and the few that take WHO standardized waters. A Simple Water Treatment Device is recommended. The device consists of four chambers, two pumping machines, alum and chlorine for treatment. It is equipped with 12 to 13 valves (depending on the position of the chambers);and the entire system is powered by electricity. It will control water borne diseases such as typhoid, schistotomiasis, diarrhea and dysentery, hepatitis, cholera and others;potable water will be available for domestic, recreational and industrial uses;enough for use in the Free Trade Zone and at the forth coming airport;the Eighteen Golf Course will not have challenges of potable water;and forces and military formations within and around the peninsula can rely on the source for every use. It is estimated that the system that can provide average of 100,000 liters of water a day will cost N720,000:00, that is, outside the cost of electricity. The system requires regular maintenance. This device could be applied anywhere.

Prevalence of <i>Helicobacter pylori</i>and hygiene practices among public secondary school students in Ikeja local government area, Lagos, Nigeria

This study determined prevalence of Helicobacter pylori and hygiene practices among public secondary school students in Ikeja Local Government Area (LGA), Lagos state, Nigeria. An institutional-based, cross-sectional study was conducted among two randomly selected secondary schools. One hundred (100) consented students participated in the study and interviews were conducted using a semi-structured questionnaire while blood samples were collected by venipuncture. Respondents’ ages were 16.1 ± 2.8 years and 54.0% were females. Mean number of persons living in a room was 7.0 ± 3.5, and however, 39.0% of the respondents lived in a room with 4 - 6 persons. The prevalence of H. pylori was 59.0% (59/100). Majority, 64.4% of those infected with H. pylori were 15 years and above while 62.7% females were tested positive to H. pylori. Some, 38.9% of the participants infected with H. pylori drink tap water while 84.7% did hand washing after visiting toilets with water and soap. Mostly, 64.0% of those tested positive to H. pylori did not experience abdominal pain in the last 4 weeks. No significant association existed between drinking water source, hand washing practice after defecation and H. pylori positivity. Routine examination of school students is required to detect Helicobacter pylori in order to commence treatment immediately and awareness about the H. pylori infection should be increased throughout secondary school to prevent further infection.

Characterisation and mapping of land subsidence based on geodetic observations in Lagos,Nigeria

The pervasive seasonal flooding,aquifer contamination,and saline water intrusion in parts of Lagos are some of the long-term effects of land subsidence caused by the excessive groundwater exploitation and land reclamation that has been taking place in the city.Efforts to monitor the extent and pattern of land deformation will help in many ways to mitigate the effects of flooding and other geohazards associated with land subsidence.In this study,we characterised and mapped the land subsidence in the Lagos city based on the analyses of geodetic data,which included Global Positioning Satellite(GPS),Envisat,Sentinel-1,and GRACE data.We applied the SBAS technique to the Envisat and Sentinel-1 datasets acquired from 2004-2011 and 2015-2019,respectively,and to perform multi-temporal analyses and produce corresponding subsidence maps over the Lagos city.The GRACE data were used to infer the extent and trend of groundwater changes at the GPS location.The results indicate that the subsidence is a widespread phenomenon in Lagos city,with subsidence rates varying between-2 mm/year and-87 mm/year.The highest subsidence rate was observed around the coastal zones and areas where heavy structures are built on landfills.With the highest rate at present,subsidence has gradually increased in the last 15 years.With the development of indiscriminate groundwater exploitation,urbanization,and rapid population growth,the subsidence rate in Lagos city is likely to rise significantly in the coming years,which,in turn,may further escalate the flood rate and other associated geohazards.

Are Drug Efflux Genes Present among <i>Mycobacterium tuberculosis</i>Isolates from Patients in Lagos, Nigeria?

A major challenge in the treatment of Tuberculosis (TB) is emergence of Multi-Drug Resistant Mycobacterium tuberculosis (MDRTB) strains. Efflux genes have been established to be among factors for drug resistance in Mycobacterium tuberculosis (M. tuberculosis) pulmonary infections by conferring bacterial ability to pump-out drugs from intracellular compartment, making it impossible for drugs to attain intracellular concentration lethal to the organism. There is paucity of data on the role of efflux pump in MDRTB in Nigerian strains of M. tuberculosis. Hence, the aim of this study was to detect the carriage, distribution and frequency of efflux pump genes among MDRTB and non-MDRTB isolates from participants with pulmonary tuberculosis in Lagos, Nigeria. This study was carried out on M. tuberculosis isolated from 1020 participants suspected of pulmonary tuberculosis in Lagos State, Nigeria. A total of 78 M. tuberculosis isolates were obtained from the participants suspected of pulmonary tuberculosis. Forty Eight isolates were confirmed as MDRTB and 30 non-MDRTB. Efflux pump genes were investigated in the isolates using the conventional polymerase chain reaction. Statistical analysis was carried out using the Statistical Package for Social Science (SPSS version 20) to compare the efflux pump gene results between MDRTB and non- MDRTB isolates. Different efflux genes types and frequency were detected in MDRTB and non-MDRTB isolates. Carriage of 2 or more alleles of efflux gene types Rv2486c (efpA), Rv2459c (jefA), Rv1877, Rv1002c, Rv0342, Rv2686c and drrC associated with MDR were detected. Additionally, the frequency of efflux genes alleles in MDRTB was significantly different from those in non- MDRTB isolates.

Prevalence and Pattern of Intestinal Parasitic Infestations among HIV Infected Children in Lagos, Nigeria

Introduction: Intestinal parasitic infections significantly affect paediatric population globally with over 800 million children at risk. The chronic nature of these infestations is associated with chronic disabilities approaching 9 million Disability Adjusted Life Years (DALYs). Co-infection of Human Immunodeficiency Virus (HIV) and intestinal parasitic infections adorned the pre-Highly Active Antiretroviral Therapy (HAART) era resulting in impaired nutritional state and dysfunctional immune system, especially amongst affected children. The success of HAART in conjunction with other life-saving measures has improved the outcome of children living with HIV. This study aimed to evaluate the prevalence and pattern of parasitic infections among children living with HIV in Lagos. Methodology: Consecutive children attending the paediatric anti-retroviral clinic were enrolled. Socio-demographic and clinical characteristics elicited from the clinical examination were recorded. Fresh stool samples of the children were obtained and examined for intestinal parasites. Data were analyzed with the Statistics Package for Social Sciences (SPSS) 20 software. Results: A total of 102 children participated in the study with a majority being males (52.9%), in primary school (73.5%) and living in urban settings (82.4%). Six children were found to harbour intestinal parasites giving a prevalence of 5.9% with Ascaris lumbricoides (50%) and Entamoeba histolytica (33.3%) being the prevalent parasites seen. Children with a Body Mass Index (BMI) Z-score < ?1 had higher estimates of intestinal parasitic infestations [p value < 0.05, OR 10.27, CI 1.72 - 61.20]. Conclusion: The prevalence of intestinal infestation was 5.9% with Ascariasis being the commonest intestinal parasitosis in our study. Malnutrition was found to be significantly associated with its occurrence.

Degradation of Urban Green Spaces in Lagos, Nigeria: Evidence from Satellite and Demographic Data

The study aimed to assess the potential of using Remote Sensing (RS) da-ta to evaluate the changes of urban green spaces in Lagos, Nigeria. Land-sat Thematic Mapper and Landsat 8 (Operational Land Imager) data pair of May 4, 1986, December 12, 2002 and January 1, 2019 covering Lagos Government Authority (LGA) were used for this study. Supervised image classification technique using Maximum Likelihood Classifier (MLC) was used to create base map which was then used for ground truthing. Ran-dom Forest (RF) classification technique using RF classifier was utilized in this study to generate the final land use land cover map. RF is an en-semble learning method for classification that operates by constructing a multitude of decision trees at training time and outputting the class that is the mode of the classes (classification). Lagos census population data was also used in this study to model population projection. Extrapolation of the model was used to predict data for the years, 2020 and 2040. Re-sults of the study revealed a reduction of urban green spaces due to agri-culture and settlement. While the remote mapping revealed the gradual dispersion of ecosystem degradation indicators spread across the state, there exists clusters of areas vulnerable to environmental hazards across Lagos. To mitigate these risks, the paper offered recommendations rang-ing from the need for effective policy to green planning education for city managers, developers and risk assessment. These measures will go a long way in helping sustainability and management of land resources in Lagos.

Air Pollution by Carbon Monoxide (CO) Poisonous Gas in Lagos Area Southwestern Nigeria

We examined exposure to air pollution caused by households’ wood burning of cooking, generating sets and vehicle emissions of carbon monoxide (CO) poisonous gas in the most populated urban city of Lagos Southwestern part of Nigeria. It is a known fact that many families including children and pregnant women;infant babies and individuals lost their lives due to poor quality air control policies, and inefficient control of air pollution caused by this deadly gas. Many are suffering with heart-related diseases as a result of CO poisoning and Government is not showing serious concern in this part of the world. All of the foregoing motivates this study to determine the level of human exposure to this deadly gas using Carbon Monoxide Detector so as to create the necessary adequate awareness of the quality of air within the metropolis whereby preventive measures could be put in place to curb the devastating effects on the innocent citizens, most importantly, the children.

Effect of Elevation Data Accuracy on Storm Drainage Schemes, Lagos, Nigeria

The check of elevation data is an essential step prior the start of any drainage study. An investigation for this concept was done in Lagos, Nigeria using two types of survey sources;a Digital Elevation Model (DEM) with a 15 m resolution produced from Russian Stereo Satellite images (RSS) and a LiDAR survey with a 5 m DEM resolution. A comparison between the RSS model survey and the LiDAR survey showed that LiDAR survey was more accurate than RSS survey and given high reliability. The study also showed that RSS survey could sometimes become misleading and could not assure reliability. A watershed modeling tool was used to analyze both surveys to produce the expected drainage streams. It was found that some locations using RSS had a false drainage direction when compared with higher accurate LiDAR surveys.