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Lassa fever is a viral haemorrhagic fever endemic in Nigeria. Improved surveillance and testing capacity have revealed in an increased number of reported cases and apparent geographic spread of Lassa fever in Nigeria. We described the recent four-year trend of Lassa fever in Nigeria to improve understanding of its epidemiology and inform the design of appropriate interventions. We analysed the national surveillance data on Lassa fever maintained by the Nigeria Centre for Diseases Control (NCDC) and described trends, sociodemographic, geographic distribution, and clinical outcomes. We compared cases, positivity, and clinical outcomes in the period January 2018 to December 2021. We found Lassa fever to be reported throughout the year with more than half the cases reported within the first quarter of the year, a recent increase in numbers and geographic spread of the virus, and male and adult (>18 years) preponderance. Case fatality rates were worse in males, the under-five and elderly, during off-peak periods, and among low reporting states. Lassa fever is endemic in Nigeria with a recent increase in numbers and geographical distribution. Sustaining improved surveillance, enhanced laboratory diagnosis and improved case management capacity during off-peak periods should remain a priority. Attention should be paid to the very young and elderly during outbreaks. Further research efforts should identify and address specific factors that determine poor clinical outcomes.

In low- and middle-income countries (LMIC), group antenatal care (gANC) has the potential to reshape the traditional antenatal care (ANC) service delivery model, enhancing the care experience for both women and providers. ANC non-utilization rates are high in some parts of Nigeria, the evidence-based gANC program offers a structured yet flexible model that may increase maternal and child healthcare utilization which may in turn improve outcomes. This is a longitudinal study of women who participated in the gANC program at healthcare facilities sampled in Kaduna and Kano states, Nigeria. We plan to follow this longitudinal cohort over 3 time points of 18 months and to use data on participation in the gANC program as an independent variable to predict program outcomes using multivariate analysis and propensity matching techniques. This is aimed at isolating the causal effect of the number of gANC meetings attended during the index pregnancy on the probability of delivering that pregnancy in a health facility. To achieve that objective, we used inverse-probability weighting in addition to adjusted multivariate logistic regression models. Overall, we found that there was high retention at follow-up, and generally high attendance at follow-up, with higher attendance based on other variables such as prior pregnancy and participants who were employed. We had low participants' attrition well within power analysis assumptions for the study. In terms of causal inference, there is a strong positive relationship between gANC session attendance and facility delivery, with women who attended five or more gANC sessions being approximately twice as likely to deliver in a health facility as those who attended none or one. Adjustment for a set of socio-demographic and prior pregnancy- and delivery-related variables via inverse probability weighting showed that a positive effect on facility delivery persists, especially at the highest levels of gANC session attendance. Results of this study tend to confirm the main findings from previous studies of gANC, which found that higher levels of participation resulted in higher facility delivery. This study found that it was both scalable in a diverse set of urban and rural healthcare facilities and engagement with the program among eligible women was high. Future research in the current longitudinal study will evaluate long-term effects of gANC on maternal and child health outcomes such as family planning and vaccination. The gANC program at scale in Nigeria produced high levels of participation, and resulted in increased facility birthing utilization that were consistent with previous research. Future research should examine how to optimize program impact and enhance sustainability.

Urbanization, armed conflict, and deforestation in African countries have increased the risk of zoonotic infections, which requires a One Health approach focused on the environment, animal health and human health.

The year 2020 Lassa fever (LF) outbreak had the greatest disease burden and this can place an enormous strain on the already overstretched healthcare system and can potentially increase morbidity and mortality due to infectious diseases. Therefore, having a knowledgeable healthcare workforce with appropriate skills and competencies to prevent and manage outbreaks of a neglected infectious disease such as LF in Nigeria will potentially enhance public health. Thus, this survey assessed the level of knowledge of LF and its prevention and control (PC) measures amongst the healthcare workers (HCWs) during a LF outbreak in Katsina state, Nigeria. During this cross-sectional survey, HCWs complete a validated 29-item questionnaire comprising 18 items on the knowledge of LF and its PC measures and an item on global self-evaluation of their LF knowledge. Psychometric properties of the questionnaire were evaluated. Chi-square and binary logistic regression analyses were conducted. Out of 435 HCWs invited, a total of 400 participated in the study (92% response rate). The majority of participants (51.8%) demonstrated inadequate LF knowledge, with 62.9% of those scoring low having a high self-perception of their LF knowledge with the global scale. This LF knowledge over-estimation was predicted by LF training status (odds ratio (OR) 2.53; 95% CI: 1.49-4.30; p = 0.001). The level of LF knowledge and its PC measures among the study participants was low (11.60±8.14, 64.4%) and predicted by participants' LF training status (OR 2.06; 95% CI: 1.19-3.57; p = 0.009), place of work (OR 1.82; 95% CI: 1.07-3.08; p = 0.03) and their designations (OR 2.40; 95% CI: 1.10-5.22; p = 0.03). The level of knowledge of LF and its PC measures among the HCWs surveyed was suboptimal and participants' LF training status, place of work and occupational category were the significant predictors. In addition, LF knowledge overestimation on a global scale was observed among a majority of HCWs and this was also predicted by LF training status. Therefore, there is a critical need for health authorities in Nigeria to prioritize continuous on-the-job training of HCWs on priority neglected tropical diseases such as Lassa fever.

Northern Nigeria has had historically low antenatal care (ANC) utilization rates with poor health outcomes. Previous studies have shown that group antenatal care (gANC) improves ANC behavior and pregnancy outcomes. The gANC has been adopted in Kaduna and Kano States, Nigeria. This paper presents baseline findings from the implementation of the gANC program in Kaduna and Kano States, Nigeria, based on data collected from 1269 and 1200 pregnant women, respectively, from March to April 2024. Analyses of sociodemographic and pregnancy behavior data were performed. Participants were mostly between the age of 19 and 31 years, married or living with a partner, with over 50% having their own businesses. Over 62% and 34% had completed secondary- or higher-level education, with 60% and 80% living in urban areas in Kaduna and Kano States, respectively. In Kano State, >60% of the women had their last delivery at home, with 41.6% not assisted by a skilled birth attendant. In Kaduna, >63% delivered in the hospital and >50% had skilled attendance during labor. Almost half had not used contraceptives previously. This study has provided baseline evaluation data for the implementation of gANC in two states in Nigeria. Subsequent longitudinal data will examine the impact of gANC utilization on perinatal outcomes and contraceptive behavior to inform the scaling of the program in the country.

Background Understanding and continually assessing the achievability of global health targets is key to reducing disease burden and mortality. The Global Task Force on Cholera Control (GTFCC) Roadmap aims to reduce cholera deaths by 90% and eliminate the disease in twenty countries by 2030. The Roadmap has three axes focusing on reporting, response and coordination. Here, we assess the achievability of the GTFCC targets in Nigeria and identify where the three axes could be strengthened to reach and exceed these goals. Methodology/Principal findings Using cholera surveillance data from Nigeria, cholera incidence was calculated and used to model time-varying reproduction number (R). A best fit random forest model was identified using R as the outcome variable and several environmental and social covariates were considered in the model, using random forest variable importance and correlation clustering. Future scenarios were created (based on varying degrees of socioeconomic development and emissions reductions) and used to project future cholera transmission, nationally and sub-nationally to 2070. The projections suggest that significant reductions in cholera cases could be achieved by 2030, particularly in the more developed southern states, but increases in cases remain a possibility. Meeting the 2030 target, nationally, currently looks unlikely and we propose a new 2050 target focusing on reducing regional inequities, while still advocating for cholera elimination being achieved as soon as possible. Conclusion/Significance The 2030 targets could potentially be reached by 2030 in some parts of Nigeria, but more effort is needed to reach these targets at a national level, particularly through access and incentives to cholera testing, sanitation expansion, poverty alleviation and urban planning. The results highlight the importance of and how modelling studies can be used to inform cholera policy and the potential for this to be applied in other contexts.

Background: The COVID-19 pandemic led to the implementation of additional infection prevention and control (IPC) measures. In healthcare settings, the risk of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infections remains high for patients, healthcare workers, and visitors. Ultraviolet germicidal irradiation (UVGI) has been explored as a potential alternative for surface disinfection within healthcare facilities and hospitals.Aim: This study evaluates the effectiveness of UVGI as a surface cleaning method for COVID-19.Setting: Healthcare settings.Method: A systematic literature review was conducted following PRISMA guidelines. Databases searched from 01 January 2020 to 31 August 2022, included Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and Cochrane Database of Systematic Reviews (CDSR), with no language restrictions. Two independent researchers screened and extracted data. Proportions and relative risk were calculated, and the evidence quality was assessed using the GRADE approach.Results: Three studies were included, all focusing on terminal disinfection of patient rooms. None directly assessed the effect of UVGI on hospital-acquired SARS-CoV-2 infections. One study found UVGI reduced viral contamination post-regular cleaning in healthcare settings (RR: 1.83, 95% CI: 1.02–3.31). Other studies reported complete viral ribonucleic acid (RNA) clearance after 15 min of irradiation at 254 nm and 15 s at 222 nm, respectively.Conclusion: The evidence on UVGI reducing SARS-CoV-2 contamination on surfaces is of very low certainty.Contribution: The very low certainty prevents a definitive conclusion on its effectiveness in preventing COVID-19 in healthcare settings. Further research is needed to strengthen the evidence base.

Introduction: Compliance with the Government’s lockdown policy is required to curtail community transmission of Covid-19 infection. The objective of this research was to identify places Nigerians visited during the lockdown to help prepare for a response towards future infectious diseases of public health importance similar to Covid-19.Methods: This was a secondary analysis of unconventional data collected using Google Forms and online social media platforms during the COVID-19 lockdown between April and June 2020 in Nigeria. Two datasets from: i) partnership for evidence-based response to COVID-19 (PERC) wave-1 and ii) College of Medicine, University of Lagos perception of and compliance with physical distancing survey (PCSH) were used. Data on places that people visited during the lockdown were extracted and compared with the sociodemographic characteristics of the respondents. Descriptive statistics were calculated for all independent variables and focused on frequencies and percentages. Chi-squared test was used to determine the significance between sociodemographic variables and places visited during the lockdown. Statistical significance was determined by P<0.05. All statistical analyses were carried out using SPSS version 22. Results: There were 1304 and 879 participants in the PERC wave-1 and PCSH datasets, respectively. The mean age of PERC wave-1 and PCSH survey respondents was 31.8 [standard deviation (SD)=8.5] and 33.1 (SD=8.3) years, respectively. In the PCSH survey, 55.9% and 44.1% of respondents lived in locations with partial and complete covid-19 lockdowns, respectively. Irrespective of the type of lockdown, the most common place visited during the lockdown was the market (shopping); reported by 73% of respondents in states with partial lockdown and by 68% of respondents in states with the complete lockdown. Visits to families and friends happened more in states with complete (16.1%) than in states with partial (8.4%) lockdowns.Conclusions: Markets (shopping) were the main places visited during the lockdown compared to visiting friends/family, places of worship, gyms, and workplaces. It is important in the future for the Government to plan how citizens can safely access markets and get other household items during lockdowns for better adherence to stay-at-home directives for future infectious disease epidemics.

The 10-week internship for the pilot cohort of resident doctors from various teaching hospitals in Nigeria was a very rewarding experience. The internship was a beautiful immersion into field epidemiology, rumor surveillance, risk communication, digital tools for surveillance, developing strategic documents, line lists interpretation, weekly presentations and outbreak response coordination alongside working briefly as an incident manager for the Yellow Fever technical working group. Some of the learning points included: meeting coordination, contributions to ongoing research, review of training documents for surveillance officers and the mechanisms of escalating and de-escalating technical working groups in the face of outbreaks and working as an incident manager. There is the need to continue this internship to strengthen the capacity of our emerging health workforce in residency training to address our public health priorities in Nigeria.