Perceptions of the COVID-19 Vaccine and Willingness to Receive Vaccination among Health Workers in Nigeria: A Cross-sectional Study

BACKGROUND

COVID-19 vaccine hesitancy is a major barrier to vaccine uptake, and the achievement of herd immunity is required to reduce morbidity and mortality and protect the most vulnerable populations. In Nigeria, COVID-19 vaccine hesitancy has been high, and uptake remains very low. Healthcare workers (HCWs) in Nigeria can help support public health efforts to increase vaccine uptake.

AIM

This study evaluates Nigerian HCWs' acceptance and intent to recommend the COVID-19 vaccine.

SUBJECTS AND METHODS

Cross-sectional survey among 1,852 HCWs in primary, secondary, and tertiary care settings across Nigeria. Respondents included doctors, nurses, pharmacy workers, and clinical laboratory professionals who have direct clinical contact with patients in various healthcare settings. A 33-item questionnaire was used in the study, with two of the questions focused on the COVID-19 vaccine. The responses to the two questions were analyzed using Chi-square (c2) tests and independent t-tests to determine the acceptance of the vaccine.

RESULTS

The majority of respondents were younger than 34 years (n = 1,227; 69.2%) and primarily worked in hospitals (n = 1,278; 72.0%). Among the respondents, 79.2% (n = 1,467) endorsed the COVID-19 vaccine as a critical tool in reducing the impact of the disease, and 76.2% (n = 1,412) will accept and recommend the vaccine to their patients. The younger HCWs were more likely to endorse and recommend the vaccine to their patients.

CONCLUSION

There is a moderately high COVID-19 vaccine acceptance rate among HCWs surveyed in our study. The confidence of HCWs in its use and their willingness to recommend it to their patients can provide a potentially useful element in increasing acceptance by the larger population in Nigeria.

The Impact of Co-Morbidities on the Pattern of Blood Pressure Control in Elderly Hypertensives in Nigeria

INTRODUCTION

The elderly hypertensive patients often have increased prevalence of cardiometabolic risk factors and their attendant co-morbidities. The aim of this study was to determine the prevalence of cardiometabolic risk factors and blood pressure control among elderly hypertensive patients, and to determine the influence of modifiable cardiometabolic risk factors on the control of hypertension among elderly hypertensive patients.

SUBJECTS AND METHODS

A case-control comparative and hospitalbased study involving a total of 190 consenting elderly (>65 years), hypertensive patients (subjects) (n=100) and normotensive controls (n=90) was carried out over a period of ten months. Using interviewer-administered questionnaire, biodata and information regarding their lifestyle was obtained. Standard protocols were used to measure blood pressure, weight, height, waist circumference, fasting plasma glucose and fasting lipid profile of the subjects. Body mass index was derived from weight and height.

RESULTS

The mean age of the subjects was 71.5 ± 6.3 years and the controls was 72.3 ± 7.2 years. Forty-eight percent (48%) and 47.8% of the subjects and controls were females (p = 0.651). The level of control of hypertension was poor in over two-thirds (68%) of the elderly hypertensive patients. The prevalence of modifiable cardiometabolic risk factors burden was higher in the hypertensive subjects when compared with the controls. Prevalence of Dyslipidaemia was 76% in the subjects and 51% in the controls (p = 0.004). Prevalence of Diabetes Mellitus was 40% among the subjects and 17.8% in the controls (p = 0.0001); prevalence of Obesity was 24% in the subjects and 4.4% in the controls (p=<0.001); prevalence of excess alcohol intake was 49% in the subjects and 14.4% in the controls (p=<0.001). Prevalence of sedentary life style was high in both the subjects (53%) and controls (50%), p=0.679. Poor blood pressure control was predicted by dyslipidaemia and central obesity.

CONCLUSION

The level of control of hypertension was poor among the elderly and modifiable cardiometabolic risk factors were relatively prevalent. Central obesity and dyslipidaemia were predictive of poor control of hypertension. Addressing these factors may therefore improve blood pressure control.

Knowledge and utilization of electrocardiogram among resident doctors in family medicine in Nigeria

BACKGROUND

Electrocardiogram (ECG) is a simple, readily affordable, and noninvasive tool for the evaluation of cardiac disorders. There is a dearth of information on the utility of ECG in general practice in Nigeria. We assessed the knowledge and utilization of ECG among family medicine residents in Nigeria.

MATERIALS AND METHODS

A cross-sectional evaluation was conducted between November 2011 and May 2012 in four family medicine training centers in Nigeria. A self-administered questionnaire was used to obtain information from the resident doctors regarding their ECG requests, preferred source of interpretation, most common ECG diagnosis, and update of ECG knowledge.

RESULTS

Only 61 out of 120 questionnaires (50.8%) were returned. The respondents were mostly between 31 and 40 years (54.7%) and were predominantly males (73.8%) and senior residents (65.6%). Fifty-four (88.3%) respondents made <5 ECG requests/week, and the most common indication was hypertension (50%). ECG interpretation was either self-reported (41%), by a cardiologist (26.5%), or automated reports (21.3%). Self-reporting of ECG was more common among senior residents (P < 0.01). Left ventricular hypertrophy was the most common ECG diagnosis (55.8%). About 69% of respondents did not update their knowledge of ECG. Most respondents (50%) reported basic interpretation as the aspect of ECG for which further learning was desired. Teaching ECG to resident doctors in the update courses of the postgraduate medical colleges and continuing medical education (CME) activities was adjudged the best way to improve knowledge/utility (61.1%).

CONCLUSION

The attitude to and utility of ECG among family medicine residents in Nigeria is poor. Improved knowledge, attitude, and utilization of ECG through curriculum revision, hands-on tutorials, and CMEs are highly recommended.

Relationship between Six-Minute Walk Test and Left Ventricular Systolic Function in Nigerian Patients with Heart Failure

BACKGROUND

Heart failure (HF) is a major public health problem. The six-minute walk test (6MWT) is a submaximal exercise test performed even by HF patients not tolerating maximal exercise testing. The left ventricular ejection fraction is one of the strongest indicators of mortality in HF. Literature reports that relationship between 6MWT and (Left Ventricular Systolic Function (LVSF) were not homogenous, hence the need for this study.

METHODS

One hundred and forty consenting HF patients in NYHA II and III were consecutively recruited after obtaining ethical clearance. The patients were made to walk on a level ground at their own convenient pace while attempting to cover as much ground as possible in six minutes. Echocardiography was also performed on all the patients.

RESULTS

Eighty-five (60.7%) were women. The population mean age was 48.2 ± 14.5 years. The average distance walked was 272.2 ± 114.0 meters and the mean ejection fraction (EF) was 36.73 ± 15.04. Patients in NYHA II significantly walked longer than those in NYHA III (334.81 ± 98.80m vs 204.05 ± 87.66m; p<0.001). There was no correlation between the distance walked and LVSF; EF(r = -0.402, P = 0.534), SF (r = -0.128, P = 0.878).The independent predictors of distance walked were sex (p=0.021) and NYHA stage(p<0.0001).

CONCLUSION

NYHA stage and sex independently predicted the distance walked in our HF patients. There was an inverse relationship between 6MWT and NYHA, with no correlation between 6MWT and LVSF. 6MWT therefore, appears not to be a good measure of LVSF as assessed by M-mode derived EF, in our HF patients.

Liver function test abnormalities in Nigerian patients with human immunodeficiency virus and hepatitis B virus co-infection

Data on baseline hepatic function of HIV and hepatitis B virus (HBV) co-infected patients are limited in sub-Saharan Africa. We assessed liver function test (LFT) abnormalities in Nigerian patients with HIV/HBV co-infection to highlight the impact of HIV on HBV-related liver disease in sub-Saharan Africa. A cross-sectional study involving 100 HIV/HBV co-infected patients and 100 age- and sex-matched HBV mono-infected controls. Blood testing for HIV antibodies, CD4+ cell count, hepatitis B surface antigen (HBsAg), hepatitis B e antigen (HBeAg), LFTs, platelet count, fasting blood glucose and lipid profile were carried out. Non-invasive hepatic fibrosis scores (aspartate aminotransferase-platelet ratio index [APRI] and FIB-4) were also calculated. Co-infected patients had deranged liver enzymes more than the controls (77% versus 64%, P = 0.04). The predominant patterns of enzyme derangement in co-infected patients were either predominantly ↑ALP (30% versus 4%, P < 0.0001) or mixed (30% versus 15%, P = 0.01) but predominantly ↑AST/ALT in the controls (25% versus 9%, P = 0.003). Co-infected patients had higher fibrosis scores for both APRI (P = 0.002) and FIB-4 (P = 0.0001). On further analysis, LFT abnormalities and fibrosis scores were only significantly higher in co-infected patients in the immune clearance and HBeAg-negative chronic hepatitis phases. LFT abnormalities are common in Nigerians with HBV infection and co-infection with HIV negatively impacts on hepatic function.