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Ogoina D, Dalhat MM, Denue BA, Okowa M, Chika-Igwenyi NM, Yusuff HA, Christian UC, Adekanmbi O, Ojimba AO, Aremu JT, Habila KL, Oiwoh SO, Tobin EA, Johnson SM, Olaitan A, Onyeaghala C, Gomerep SS, Alasia D, Onukak AE, Mmerem J, Unigwe U, Falodun O, Kwaghe V, Awang SK, Sunday M, Maduka CJ, Na'uzo AM, Owhin SO, Mohammed AA, Adeiza MA. Clinical characteristics and predictors of human mpox outcome during the 2022 outbreak in Nigeria: a cohort study. Lancet Infect Dis 2023; 23:1418-1428. [PMID: 37625431 DOI: 10.1016/s1473-3099(23)00427-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 06/21/2023] [Accepted: 06/27/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Research from sub-Saharan Africa that contributes to our understanding of the 2022 mpox (formerly known as monkeypox) global outbreak is insufficient. Here, we describe the clinical presentation and predictors of severe disease among patients with mpox diagnosed between Feb 1, 2022, and Jan 30, 2023 in Nigeria. METHODS We did a cohort study among laboratory-confirmed and probable mpox cases seen in 22 mpox-treatment centres and outpatient clinics across Nigeria. All individuals with confirmed and probable mpox were eligible for inclusion. Exclusion criteria were individuals who could not be examined for clinical characterisation and those who had unknown mortality outcomes. Skin lesion swabs or crust samples were collected from each patient for mpox diagnosis by PCR. A structured questionnaire was used to document sociodemographic and clinical data, including HIV status, complications, and treatment outcomes from the time of diagnosis to discharge or death. Severe disease was defined as mpox associated with death or with a life-threatening complication. Two logistic regression models were used to identify clinical characteristics associated with severe disease and potential risk factors for severe disease. The primary outcome was the clinical characteristics of mpox and disease severity. FINDINGS We enrolled 160 people with mpox from 22 states in Nigeria, including 134 (84%) adults, 114 (71%) males, 46 (29%) females, and 25 (16%) people with HIV. Of the 160 patients, distinct febrile prodrome (n=94, 59%), rash count greater than 250 (90, 56%), concomitant varicella zoster virus infection (n=48, 30%), and hospital admission (n=70, 48%) were observed. Nine (6%) of the 160 patients died, including seven (78%) deaths attributable to sepsis. The clinical features independently associated with severe disease were a rash count greater than 10 000 (adjusted odds ratio 26·1, 95% CI 5·2-135·0, p<0·0001) and confluent or semi-confluent rash (6·7, 95% CI 1·9-23·9). Independent risk factors for severe disease were concomitant varicella zoster virus infection (3·6, 95% CI 1·1-11·5) and advanced HIV disease (35·9, 95% CI 4·1-252·9). INTERPRETATION During the 2022 global outbreak, mpox in Nigeria was more severe among those with advanced HIV disease and concomitant varicella zoster virus infection. Proactive screening, management of co-infections, the integration and strengthening of mpox and HIV surveillance, and preventive and treatment services should be prioritised in Nigeria and across Africa. FUNDING None.
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Affiliation(s)
- Dimie Ogoina
- Infectious Diseases Unit, Department of Internal Medicine, Niger Delta University Teaching Hospital, Niger Delta University, Yenagoa, Bayelsa, Nigeria.
| | | | | | - Mildred Okowa
- Department of Public Health, Ministry of Health, Asaba, Delta, Nigeria
| | - Nneka Marian Chika-Igwenyi
- Infectious Diseases Unit, Internal Medicine Department, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi , Nigeria
| | | | - Umenzekwe Chukwudi Christian
- Infectious Diseases and Tropical Medicine Unit, Department of Internal Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra, Nigeria
| | - Olukemi Adekanmbi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | | | - John Tunde Aremu
- Infectious Diseases Unit, Federal Teaching Hospital Gombe, Gombe, Nigeria
| | - Kambai Lalus Habila
- Kaduna State Emergency Medical Services and Ambulance System, Kaduna, Kaduna, Nigeria
| | | | - Ekaete Alice Tobin
- Institute of Viral Haemorrhagic Fever and Emerging Pathogens, Irrua Specialist Teaching Hospital, Irrua, Edo, Nigeria
| | - Simon Mafuka Johnson
- Department of Internal Medicine, Federal University Teaching Hospital, Owerri, Imo, Nigeria
| | - Abimbola Olaitan
- Department of Internal Medicine, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun, Nigeria
| | - Chizaram Onyeaghala
- Department of Internal Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers, Nigeria
| | - Simji Samuel Gomerep
- Infectious Diseases Unit, Jos University Teaching Hospital, and Medicine Department, University of Jos, Plateau, Nigeria
| | - Datonye Alasia
- Department of Internal Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers, Nigeria
| | - Asukwo E Onukak
- Department of Internal Medicine, University of Uyo, Uyo, Nigeria
| | - Juliet Mmerem
- Infectious Disease and Tropical Medicine Unit, Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Uche Unigwe
- Infectious Disease and Tropical Medicine Unit, Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Olanrewaju Falodun
- Department of Internal Medicine, National Hospital Abuja, Federal Capital Territory, Nigeria
| | - Vivian Kwaghe
- Department of Internal Medicine, University of Abuja Teaching Hospital, Gwagalada, Abuja, Federal Capital Territory, Nigeria
| | - Sati Klein Awang
- Infectious Diseases Unit, Department of Internal Medicine, Modibo Adama University Teaching Hospital, Yola, Adamawa, Nigeria
| | - Mogaji Sunday
- Department of Public Health, Federal Medical Centre, Ebute Metta, Lagos, Nigeria
| | | | - Aliyu Mamman Na'uzo
- Department of Paediatrics, Federal Medical Centre, Birnin Kebbi, Kebbi, Nigeria
| | - Sampson Omagbemi Owhin
- Department of Medicine, Clinical Haematology Unit, Federal Medical Center, Owo, Ondo, Nigeria
| | - Abdullahi Asara Mohammed
- Infectious Diseases and Tropical Medicine Unit, Ahmadu Bello University Teaching Hospital, Shika-Zaria, Kaduna, Nigeria
| | - Mukhtar Abdulmajid Adeiza
- Infectious Diseases and Tropical Medicine Unit, Ahmadu Bello University Teaching Hospital, Shika-Zaria, Kaduna, Nigeria
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Elimian K, Yennan S, Musah A, Cheshi ID, King C, Dunkwu L, Mohammed AL, Ekeng E, Akande OW, Ayres S, Gandi B, Pembi E, Saleh F, Omar AN, Crawford E, Olopha OO, Nnaji R, Muhammad B, Luka-Lawal R, Ihueze AC, Olatunji D, Ojukwu C, Akinpelu AM, Adaga E, Abubakar Y, Nwadiuto I, Ngishe S, Alowooye AB, Nwogwugwu PC, Kamaldeen K, Abah HN, Chukwuebuka EH, Yusuff HA, Mamadu I, Mohammed AA, Peter S, Abbah OC, Oladotun PM, Oifoh S, Olugbile M, Agogo E, Ndodo N, Babatunde O, Mba N, Oladejo J, Ilori E, Alfvén T, Myles P, Ochu CL, Ihekweazu C, Adetifa I. Epidemiology, diagnostics and factors associated with mortality during a cholera epidemic in Nigeria, October 2020-October 2021: a retrospective analysis of national surveillance data. BMJ Open 2022; 12:e063703. [PMID: 36123095 PMCID: PMC9486350 DOI: 10.1136/bmjopen-2022-063703] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Nigeria reported an upsurge in cholera cases in October 2020, which then transitioned into a large, disseminated epidemic for most of 2021. This study aimed to describe the epidemiology, diagnostic performance of rapid diagnostic test (RDT) kits and the factors associated with mortality during the epidemic. DESIGN A retrospective analysis of national surveillance data. SETTING 33 of 37 states (including the Federal Capital Territory) in Nigeria. PARTICIPANTS Persons who met cholera case definition (a person of any age with acute watery diarrhoea, with or without vomiting) between October 2020 and October 2021 within the Nigeria Centre for Disease Control surveillance data. OUTCOME MEASURES Attack rate (AR; per 100 000 persons), case fatality rate (CFR; %) and accuracy of RDT performance compared with culture using area under the receiver operating characteristic curve (AUROC). Additionally, individual factors associated with cholera deaths and hospitalisation were presented as adjusted OR with 95% CIs. RESULTS Overall, 93 598 cholera cases and 3298 deaths (CFR: 3.5%) were reported across 33 of 37 states in Nigeria within the study period. The proportions of cholera cases were higher in men aged 5-14 years and women aged 25-44 years. The overall AR was 46.5 per 100 000 persons. The North-West region recorded the highest AR with 102 per 100 000. Older age, male gender, residency in the North-Central region and severe dehydration significantly increased the odds of cholera deaths. The cholera RDT had excellent diagnostic accuracy (AUROC=0.91; 95% CI 0.87 to 0.96). CONCLUSIONS Cholera remains a serious public health threat in Nigeria with a high mortality rate. Thus, we recommend making RDT kits more widely accessible for improved surveillance and prompt case management across the country.
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Affiliation(s)
- Kelly Elimian
- Nigeria Centre for Disease Control, Abuja, Nigeria
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | | | - Anwar Musah
- Department of Risk and Disaster Reduction, University College London, London, UK
| | | | - Carina King
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | | | | | - Eme Ekeng
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Oluwatosin Wuraola Akande
- Department of Epidemiology and Community Health, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Stephanie Ayres
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | | | | | - Fatima Saleh
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | | | | | | | | | | | | | | | | | | | | | - Ene Adaga
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Yusuf Abubakar
- Zamfara State Ministry of Health, Zamfara State, Nigeria
| | | | - Samuel Ngishe
- Public Health, Ministry of Health, Benue State, Makurdi, Nigeria
| | | | | | | | | | | | | | - Ibrahim Mamadu
- World Health Organization Country Office for Nigeria, Abuja, Nigeria
| | | | - Sarah Peter
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | | | | | | | | | | | | | | | - Nwando Mba
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | - John Oladejo
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Elsie Ilori
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Tobias Alfvén
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Puja Myles
- Clinical Practice Research Datalink, London, UK
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Elimian KO, Ochu CL, Ebhodaghe B, Myles P, Crawford EE, Igumbor E, Ukponu W, Olayinka A, Aruna O, Dan-Nwafor C, Olawepo OA, Ogunbode O, Atteh R, Nwachukwu W, Venkatesan S, Obagha C, Ngishe S, Suleiman K, Usman M, Yusuff HA, Nwadiuto I, Mohammed AA, Usman R, Mba N, Aderinola O, Ilori E, Oladejo J, Abubakar I, Ihekweazu C. Patient characteristics associated with COVID-19 positivity and fatality in Nigeria: retrospective cohort study. BMJ Open 2020; 10:e044079. [PMID: 33334842 PMCID: PMC7747485 DOI: 10.1136/bmjopen-2020-044079] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/05/2020] [Accepted: 11/10/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Despite the increasing disease burden, there is a dearth of context-specific evidence on the risk factors for COVID-19 positivity and subsequent death in Nigeria. Thus, the study objective was to identify context-specific factors associated with testing positive for COVID-19 and fatality in Nigeria. DESIGN Retrospective cohort study. SETTING COVID-19 surveillance and laboratory centres in 36 states and the Federal Capital Territory reporting data to the Nigeria Centre for Disease Control. PARTICIPANTS Individuals who were investigated for SARS-CoV-2 using real-time PCR testing during the study period 27 February-8 June 2020. METHODS COVID-19 positivity and subsequent mortality. Multivariable logistic regression analyses were performed to identify factors independently associated with both outcome variables, and findings are presented as adjusted ORs (aORs) and 95% CIs. RESULTS A total of 36 496 patients were tested for COVID-19, with 10 517 confirmed cases. Of 3215 confirmed cases with available clinical outcomes, 295 died. Factors independently associated with COVID-19 positivity were older age (p value for trend<0.0001), male sex (aOR 1.11, 95% CI 1.04 to 1.18) and the following presenting symptoms: cough (aOR 1.23, 95% CI 1.13 to 1.32), fever (aOR 1.45, 95% CI 1.45 to 1.71), loss of smell (aOR 7.78, 95% CI 5.19 to 11.66) and loss of taste (aOR 2.50, 95% CI 1.60 to 3.90). An increased risk of mortality following COVID-19 was observed in those aged ≥51 years, patients in farming occupation (aOR 7.56, 95% CI 1.70 to 33.53) and those presenting with cough (aOR 2.06, 95% CI 1.41 to 3.01), breathing difficulties (aOR 5.68, 95% CI 3.77 to 8.58) and vomiting (aOR 2.54, 95% CI 1.33 to 4.84). CONCLUSION The significant risk factors associated with COVID-19 positivity and subsequent mortality in the Nigerian population are similar to those reported in studies from other countries and should guide clinical decisions for COVID-19 testing and specialist care referrals.
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Affiliation(s)
- Kelly Osezele Elimian
- Prevention, Programme and Knowledge Management, Nigeria Centre for Disease Control, Abuja, Nigeria
- Department of Microbiology, Faculty of Life Sciences, University of Benin, Benin City, Nigeria
| | - Chinwe Lucia Ochu
- Prevention, Programme and Knowledge Management, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Blessing Ebhodaghe
- Prevention, Programme and Knowledge Management, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Puja Myles
- Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Emily E Crawford
- Prevention, Programme and Knowledge Management, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Ehimario Igumbor
- Prevention, Programme and Knowledge Management, Nigeria Centre for Disease Control, Abuja, Nigeria
- School of Public Health, University of the Western Cape, Bellville, South Africa
| | - Winifred Ukponu
- Center for Global Health Practice and Impact, Georgetown University, Abuja, Nigeria
| | - Adobola Olayinka
- WHO, Abuja, Nigeria
- Ahmadu Bello University, Zaria, Kaduna, Nigeria
| | - Olusola Aruna
- IHR Strengthening Project, Global Public Health, Public Health England, London, UK
- Public Health England, British High Commission Nigeria, Abuja, Nigeria
| | - Chioma Dan-Nwafor
- Surveillance and Epidemiology, Nigeria Centre for Disease Control, Abuja, FCT, Nigeria
| | | | - Oladipo Ogunbode
- Prevention, Programme and Knowledge Management, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Rhoda Atteh
- Surveillance and Epidemiology, Nigeria Centre for Disease Control, Abuja, FCT, Nigeria
| | - William Nwachukwu
- Surveillance and Epidemiology, Nigeria Centre for Disease Control, Abuja, FCT, Nigeria
| | - Sudhir Venkatesan
- EMEA Data Science Hub, IQVIA, London, UK
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | | | | | | | - Rabi Usman
- Ministry of Health, Zamfara State, Zamfara, Nigeria
| | - Nwando Mba
- Public Health Laboratory Services, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Olaolu Aderinola
- Health Emergency Preparedness and Response, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Elsie Ilori
- Surveillance and Epidemiology, Nigeria Centre for Disease Control, Abuja, FCT, Nigeria
| | - John Oladejo
- Health Emergency Preparedness and Response, Nigeria Centre for Disease Control, Abuja, Nigeria
| | | | - Chikwe Ihekweazu
- Office of the Director General, Nigeria Centre for Disease Control, Abuja, Nigeria
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Balogun SA, Yusuff HA, Yusuf KQ, Al-Shenqiti AM, Balogun MT, Tettey P. Maternal education and child immunization: the mediating roles of maternal literacy and socioeconomic status. Pan Afr Med J 2017; 26:217. [PMID: 28690731 PMCID: PMC5491723 DOI: 10.11604/pamj.2017.26.217.11856] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 04/19/2017] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Previous studies in Nigeria have documented significant association between maternal education and child immunization. However, little is known about the pathway through which maternal education improves immunization uptake. This study aims to examine whether maternal literacy and socioeconomic status mediates the relationship between maternal education and complete immunization coverage in children. METHODS Nationally representative data from the first wave of the Nigeria General Household Survey-Panel were used, which includes 661 children aged one year and below. Regression analyses were used to model the association between maternal education and child's immunization uptake; we then examined whether maternal literacy and household economic status mediates this association. RESULTS Of the 661 children, 40% had complete immunization. The prevalence ratio (PR) of complete immunization in children whose mothers were educated versus those whose mothers were not educated was 1.44 (95% CI: 1.16-1.77). Maternal literacy substantially reduced the estimated association between maternal education and complete immunization by 90%, whereas household economic status reduced the estimates by 27%. CONCLUSION These findings suggest that complete immunization was higher in children whose mothers were educated, partly because maternal education leads to acquisition of literacy skills and better health-seeking behavior which then improves immunization uptake for their children. Socioeconomic status is an alternative pathway but with less substantial indirect effect.
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Affiliation(s)
- Saliu Adejumobi Balogun
- Menzies Institute for Medical Research, University of Tasmania, Australia.,Otun Centre for Health and Social Research, Lagos, Nigeria
| | - Hakeem Abiola Yusuff
- Otun Centre for Health and Social Research, Lagos, Nigeria.,State Ministry of Health, Abeokuta, Ogun State, Nigeria
| | - Kehinde Quasim Yusuf
- College of Medical Rehabilitation Sciences, Taibah University, Madinah, Saudi Arabia
| | | | | | - Prudence Tettey
- Menzies Institute for Medical Research, University of Tasmania, Australia
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