Explore the vast range of titles available.

•Knowledge of Hepatitis B vaccine birth dose within 24 h (valid birth dose) was low.•Receipt of valid Hepatitis B vaccine birth dose (HepB-BD) was equally low.•Maternal knowledge was a predictor of valid HepB-BD uptake.•Delivery at health facility offering routine immunization was a predictor of HepB-BD.•Integration of child delivery and immunization services was recommended. World Health Organization recommends hepatitis B vaccine birth dose for all infants within 24 hours of birth as the most cost-effective measure to prevent perinatal hepatitis B virus infection (HBV). We assessed and identified the predictors of maternal knowledge and infants’ uptake of valid hepatitis B vaccine birth dose (HepB-BD). We conducted a hospital-based cross-sectional survey among 366 mother-infant attendees of routine immunization clinics selected by multi-stage sampling technique in Enugu State, Nigeria. We collected data on socio-demographic characteristics, delivery history, maternal knowledge and infant’s receipt of valid HepB-BD with interviewer-administered questionnaire. Maternal knowledge was assessed using nine domain questions. Overall, good knowledge was defined as a score of ≥50%. Only infants who received first hepatitis B dose within 24 hours were considered to have received valid BD. We calculated frequencies, performed Chi square test and logistic regression. One hundred and two (29.7%) mothers knew HBV can be transmitted from mother to child; 119 (34.6%) and 156 (45.3%) knew their infant should receive valid HepB-BD and four doses for full immunization of HepB respectively. Overall, 114 (31.1%) mothers had good knowledge of HBV and 88 (26.9%) of 327 who delivered at the health facilities had valid HepB-BD. Predictors of maternal knowledge were attainment of tertiary education (adjusted Odds Ratio (aOR): 2.1, 95%CI: 1.3–3.5) and living in rural areas (aOR: 0.5, 95%CI: 0.3–0.9). Predictors of valid HepB-BD uptake were maternal knowledge (aOR: 2.4, 95%CI: 1.4–4.0) and delivery at facilities offering routine immunization services (aOR: 5.4, 95%CI: 2.5–11.9). Knowledge and uptake of valid HepB-BD were low. Health education on benefits of valid HepB-BD was given to mothers after administration of questionnaires. We disseminated findings to the State Ministry of Health and recommended integration of child delivery and immunization services for birth dose vaccines especially valid HepB-BD.

Most tobacco use begins in adolescence, causing dependence and prolonged use, and accounts for more than 8 million deaths worldwide annually. Monitoring adolescent tobacco use is critical to controlling it. Our study examined the prevalence and factors associated with tobacco use among adolescents in Nigeria. We conducted a descriptive cross-sectional study among adolescent students in Ibadan, Nigeria, aged 11 to 18 years, from March through June 2021. We used a 2-stage cluster design to select 3,199 students from 23 schools. We adapted the Global Youth Tobacco Survey Core Questionnaire, version 1.2, for data collection and used logistic regression to assess factors associated with current tobacco use. We weighted all analyses for complex survey design and differential nonresponse at school, class, and student levels. Prevalence of current use of cigarettes, smokeless tobacco, or any tobacco were 1.4%, 1.1%, and 2.0%, respectively. Predictors of current tobacco use were male sex (adjusted odds ratio [aOR] = 3.13; 95% CI, 1.53-6.42); close friends as smokers (aOR = 3.10; 95% CI, 1.77-5.41); classmates as smokers (aOR = 3.12; 95% CI, 1.15-8.49); access to cigarette (aOR = 6.65; 95% CI, 2.55-17.33); perception that smoking is attractive (aOR = 3.15; 95% CI, 1.17-8.44); exposure to secondhand smoke (aOR = 2.93; 95% CI, 1.07-8.03); and internet awareness of tobacco use (aOR = 3.22; 95% CI, 1.48-7.04). Prevalence of adolescent tobacco use was low in Ibadan. Predictors were peer influence, access to cigarettes, misperceptions about tobacco use, exposure to secondhand smoke, and tobacco advertising. We recommend an antitobacco campaign that uses a peer education strategy, a comprehensive enforcement of tobacco advertising, and a ban on public smoking.

•Receipt of Hepatitis B birth dose within 24 h (valid birth dose) was abysmally low.•Maternal awareness on timing of valid birth dose quite low.•Integration of child delivery and immunization services very poor.•Mothers recommend maternal education on benefits of valid birth dose.•Mothers request pre-positioning of birth dose vaccine at labor and maternity wards. Hepatitis B vaccine (HepB) is an effective tool in prevention of hepatitis B virus (HBV) infection. When administered at birth, it prevents mother-to-child transmission of acute and chronic HBV infection. However, despite a decade and half of implementation of HepB birth dose (HepB-BD), uptake has remained persistently low in Enugu State, Nigeria. We assessed the uptake of valid HepB-BD and the reasons given by mothers of infants for not receiving the HepB-BD in Enugu State, South-east Nigeria. An hospital-based cross-sectional survey was conducted among mother-infant pairs attending immunization clinics at randomly selected health facilities in Enugu State, Nigeria. Overall, 344 mothers and their infant children in this study were interviewed using structured questionnaire. Data on maternal reasons for non-receipt of valid HepB-BD by their infants and their recommendations on ways to improve valid HepB-BD uptake, were collected. We defined valid birth dose as the receipt of first dose of HepB within 24 h of birth. Overall, 254 (73.8%) infants did not receive valid HepB-BD. Major reasons for its non-receipt were vaccine not available at place of delivery (91.3%, n = 232), delivery did not take place on immunization day (75.6%, n = 192), lack of awareness on timing of valid HepB-BD (72.8%, n = 185), long distance from the health facility (5.1%, n = 13) and fee payment for immunization (6.3%, n = 16). Of the 384 maternal recommendations, 143 (37.2%) emphasized female literacy while 87 (22.7%) indicated pre-positioning the vaccines at labor rooms to improve valid HepB-BD uptake. The low receipt of valid HepB-BD among infants attending routine immunization clinics, found in this study were attributed to lack of maternal awareness on timing of HepB-BD and poor integration of child delivery and immunization services. We recommend educating mothers on benefits of a timely HepB-BD and pre-positioning the vaccines at the labor rooms.

To ensure the prevention of mother-to-child-transmission of HIV (MTCT), 81% of pregnant women received antiretroviral therapy (ART) in 2021 worldwide. Despite the global efforts to prevent MTCT of HIV, significant knowledge gaps persist among these women including a lack of basic knowledge of HIV and ART. This study aimed to determine the levels of HIV knowledge, knowledge of ART, and attitude toward ART in HIV-positive pregnant women in Kaduna State. It was a hospital-based, cross-sectional study among 318 HIV-positive pregnant women attending antenatal care in the nine selected hospitals using a three-stage sampling technique. Data was collected using the Open Data Kit . Up to 54.4% had a fair knowledge of ART while 75.4% of the respondents had good knowledge of HIV, and up to 98.6% had a positive attitude towards ART. Knowledge of ART and attitude to ART are positively influenced by receiving multiple counselling ( p  = 0.031, aOR = 6), being on ART for ≥ 2 years ( p  = 0.021, aOR = 6); and not taking unprescribed medications ( p  = 0.047, aOR = 17) respectively. Sustained, focused counselling and patient education are necessary to establish and optimise the required adherence in this group. Also, implement clear task-sharing strategies for health personnel to provide tailored services.

Background Maternal sepsis is a leading cause of maternal death, with the burden higher in low- and middle-income countries (LMICs). Early Warning Systems (EWS) combine clinical observations to identify a pattern consistent with an increased risk of clinical deterioration and have been introduced for monitoring sepsis risk. Maternal sepsis risks in LMICs are driven by factors at the health system and patient levels. This study assessed patient-level risk factors -age, health-seeking behaviour, comorbidities and procedures- associated with maternal sepsis in an urban tertiary hospital in Nigeria. Methods We conducted a retrospective study using health records of 4,510 patients from obstetrics and gynaecology units at a tertiary hospital in southwestern Nigeria from 2016 to 2020. To examine the association between patient-level risk factors and sepsis, we analysed data for the 565 maternal patients with a record of infection using a multiple logistic regression model. We extended the model by introducing interaction terms to assess whether the association between the risk factors and maternal sepsis varied by socio-demographic factors. Results About one-fifth of the 565 maternal patients with an infection had sepsis. Patients with sepsis had the lowest rate of live birth (29.7%) compared to those with (41.8%) and without (82.1%) an infection. Proportions of stillbirth (intrauterine fetal death) and early neonatal deaths were highest among patients with sepsis (15.3% and 1.8%) compared to those with (13.2% and 2.1%) and without (4.5% and 1.7%) an infection. Antenatal care booking status (OR: 0.17; 95% CI: 0.08–0.38) and having a catheter (OR: 2.60; 95% CI: 1.35–5.01) were significantly associated with maternal sepsis in the adjusted model. Conclusion Our results suggest that improving access to antenatal care services for pregnant women will substantially reduce the risk of maternal sepsis in the Nigerian population. Guidelines for maternal sepsis management should consider subgroups of patients at higher risk, such as those with urethral catheters.

Introduction As part of efforts to rapidly identify and care for individuals with COVID-19, trace and quarantine contacts, and monitor disease trends over time, most African countries implemented interventions to strengthen their existing disease surveillance systems. This research describes the strengths, weaknesses and lessons learnt from the COVID-19 surveillance strategies implemented in four African countries to inform the enhancement of surveillance systems for future epidemics on the continent. Methods The four countries namely the Democratic Republic of Congo (DRC), Nigeria, Senegal, and Uganda, were selected based on their variability in COVID-19 response and representation of Francophone and Anglophone countries. A mixed-methods observational study was conducted including desk review and key informant interviews, to document best practices, gaps, and innovations in surveillance at the national, sub-national, health facilities, and community levels, and these learnings were synthesized across the countries. Results Surveillance approaches across countries included - case investigation, contact tracing, community-based, laboratory-based sentinel, serological, telephone hotlines, and genomic sequencing surveillance. As the COVID-19 pandemic progressed, the health systems moved from aggressive testing and contact tracing to detect virus and triage individual contacts into quarantine and confirmed cases, isolation and clinical care. Surveillance, including case definitions, changed from contact tracing of all contacts of confirmed cases to only symptomatic contacts and travelers. All countries reported inadequate staffing, staff capacity gaps and lack of full integration of data sources. All four countries under study improved data management and surveillance capacity by training health workers and increasing resources for laboratories, but the disease burden was under-detected. Decentralizing surveillance to enable swifter implementation of targeted public health measures at the subnational level was a challenge. There were also gaps in genomic and postmortem surveillance including community level sero-prevalence studies, as well as digital technologies to provide more timely and accurate surveillance data. Conclusion All the four countries demonstrated a prompt public health surveillance response and adopted similar approaches to surveillance with some adaptations as the pandemic progresses. There is need for investments to enhance surveillance approaches and systems including decentralizing surveillance to the subnational and community levels, strengthening capabilities for genomic surveillance and use of digital technologies, among others. Investing in health worker capacity, ensuring data quality and availability and improving ability to transmit surveillance data between and across multiple levels of the health care system is also critical. Countries need to take immediate action in strengthening their surveillance systems to better prepare for the next major disease outbreak and pandemic.

Background The COVID-19 pandemic presented a myriad of challenges for the health workforce around the world due to its escalating demand on service delivery. A motivated health workforce is critical to effectual emergency response and in some settings, incentivizing health workers motivates them and ensures continuity in the provision of health services. We describe health workforce experiences with incentives and dis-incentives during the COVID-19 response in the Democratic Republic of Congo (DRC), Senegal, Nigeria, and Uganda. Methods This is a multi-country qualitative research study involving four African countries namely: DRC, Nigeria, Senegal, and Uganda which assessed the workplace incentives instituted in response to the COVID-19 pandemic. Key informant interviews ( n  = 60) were conducted with staff at ministries of health, policy makers and health workers. Interviews were virtual using the telephone or Zoom. They were audio recorded, transcribed verbatim, and analyzed thematically. Themes were identified and quotes were used to support findings. Results Health worker incentives included (i) financial rewards in the form of allowances and salary increments. These motivated health workers, sustaining the health system and the health workers’ efforts during the COVID-19 response across the four countries. (ii) Non-financial incentives related to COVID-19 management such as provision of medicines/supplies, on the job trainings, medical care for health workers, social welfare including meals, transportation and housing, recognition, health insurance, psychosocial support, and supervision. Improvised determination and distribution of both financial and non-financial incentives were common across the countries. Dis-incentives included the lack of personal protective equipment, lack of transportation to health facilities during lockdown, long working hours, harassment by security forces and perceived unfairness in access to and inadequacy of financial incentives. Conclusion Although important for worker motivation, financial and non-financial incentives generated some dis-incentives because of the perceived unfairness in their provision. Financial and non-financial incentives deployed during health emergencies should preferably be pre-determined, equitably and transparently provided because when arbitrarily applied, these same financial and non-financial incentives can potentially become dis-incentives. Moreover, financial incentives are useful only as far as they are administered together with non-financial incentives such as supportive and well-resourced work environments. The potential negative impacts of interventions such as service delivery re-organization and lockdown within already weakened systems need to be anticipated and due precautions exercised to reduce dis-incentives during emergencies.

Background The sustenance of any household is tied to the well-being of the mother's health before, during, and after pregnancy. Maternal health care has continued a downward slope, increasing maternal mortality in rural communities in Nigeria. Presently, few empirical findings connect maternal healthcare facilities' use to mothers' well-being in Nigeria. Using maternal health facilities and the well-being of rural women is crucial in achieving the United Nations’ Sustainable Development Goals 1, 2, and 3 (No poverty, zero hunger, good health, and well-being). Objective The objective of the study was to examine the level of maternal healthcare utilization and its effect on mothers’ well-being status among mothers in rural Nigeria. Methods In this study, secondary data extracted from the Nigeria’s 2018 National Demographic Health Survey was used. Data was analyzed with Multiple correspondence analysis, Fuzzy set analysis, and Extended ordered logit model. Results Women in rural Nigeria were moderate users of maternal health care services and had moderate well-being indices (0.54 ± 0.2, 0.424 ± 0.2, respectively). Mothers' moderate well-being status was increased by using maternal health care facilities, having a larger household, and having mothers who worked exclusively in agriculture. Conclusion We concluded that mothers in rural Nigeria use maternal healthcare facilities moderately, and their well-being level was improved using maternal healthcare facilities. Therefore, Nigeria’s Ministry of Health should raise awareness about the vitality of mothers using health care services before, during, and after pregnancy. In order to promote greater female participation in full-scale agricultural production, it is imperative for the Nigerian government to allocate substantial resources in the form of subsidies and incentives. The Nigerian government should source these resources from various channels, including expanded development cooperation. Additionally, policymakers should focus on designing developmental programmes specifically tailored for rural households and the health sector.

Despite changing sexual norms and mores generally perceived to be permissive of sexual expression, parents continue to serve as gateways to uptake of reproductive health services and commodities in our cultural settings. However, their support for adolescent uptake of human papilloma virus (HPV) vaccine are not well explored and documented. This study aims to assess parental knowledge and awareness of HPV infection and cervical cancer and their support for HPV vaccination for their adolescent children. In a descriptive cross sectional study 612 parents from in Ibadan North Local Government Area were interviewed using a pre-tested semi structured interviewer administered questionnaire to assess the awareness of HPV infection and cervical cancer as well as parental support for the vaccine. Only a few of the respondents were aware of HPV infection (10.5%) and the HPV vaccine (6.5%), respectively. About 64.3% of those that were aware of HPV knew it can be transmitted through sexual intercourse. However, 78.4% supported the administration of the vaccine to their adolescent daughters. Reported reasons for not supporting HPV vaccination were high cost of the vaccine (32.2%) and lack of awareness of the vaccine (49.2%). Earning a monthly income above the minimum wage of 18,000 Naira increases the likelihood of parental support for HPV vaccination uptake for adolescents (p<0.001). Ignorance and poverty remain as barriers to widespread coverage of the vaccine among adolescents. Health education and promotion on HPV infection and the HPV vaccine to the general public and subsidization of the vaccine to promote its uptake is advocated.

Introduction The coronavirus (COVID 19) pandemic is one of the most terrifying disasters of the twenty-first century. The non-pharmaceutical interventions (NPIs) implemented to control the spread of the disease had numerous positive consequences. However, there were also unintended consequences—positively or negatively related to the nature of the interventions, the target, the level and duration of implementation. This article describes the unintended economic, Psychosocial and environmental consequences of NPIs in four African countries. Methods We conducted a mixed-methods study in the Democratic Republic of Congo (DRC), Nigeria, Senegal and Uganda. A comprehensive conceptual framework, supported by a clear theory of change was adopted to encompass both systemic and non-systemic interventions. The data collection approaches included: (i) review of literature; (ii) analysis of secondary data for selected indicators; and (ii) key informant interviews with policy makers, civil society, local leaders, and law enforcement staff. The results were synthesized around thematic areas. Results Over the first six to nine months of the pandemic, NPIs especially lockdowns, travel restrictions, curfews, school closures, and prohibition of mass gathering resulted into both positive and negative unintended consequences cutting across economic, psychological, and environmental platforms. DRC, Nigeria, and Uganda observed reduced crime rates and road traffic accidents, while Uganda also reported reduced air pollution. In addition, hygiene practices have improved through health promotion measures that have been promoted for the response to the pandemic. All countries experienced economic slowdown, job losses heavily impacting women and poor households, increased sexual and gender-based violence, teenage pregnancies, and early marriages, increased poor mental health conditions, increased waste generation with poor disposal, among others. Conclusion Despite achieving pandemic control, the stringent NPIs had several negative and few positive unintended consequences. Governments need to balance the negative and positive consequences of NPIs by anticipating and instituting measures that will support and protect vulnerable groups especially the poor, the elderly, women, and children. Noticeable efforts, including measures to avoid forced into marriage, increasing inequities, economic support to urban poor; those living with disabilities, migrant workers, and refugees, had been conducted to mitigate the negative effects of the NIPs.