Uncovering the Drivers of Childhood Immunization Inequality with Caregivers, Community Members and Health System Stakeholders: Results from a Human-Centered Design Study in DRC, Mozambique and Nigeria

BACKGROUND

The importance of immunization for child survival underscores the need to eliminate immunization inequalities. Few existing studies of inequalities use approaches that view the challenges and potential solutions from the perspective of caregivers. This study aimed to identify barriers and context-appropriate solutions by engaging deeply with caregivers, community members, health workers, and other health system actors through participatory action research, intersectionality, and human-centered design lenses.

METHODS

This study was conducted in the Demographic Republic of Congo, Mozambique and Nigeria. Rapid qualitative research was followed by co-creation workshops with study participants to identify solutions. We analyzed the data using the UNICEF Journey to Health and Immunization Framework.

RESULTS

Caregivers of zero-dose and under-immunized children faced multiple intersecting and interacting barriers related to gender, poverty, geographic access, and service experience. Immunization programs were not aligned with needs of the most vulnerable due to the sub-optimal implementation of pro-equity strategies, such as outreach vaccination. Caregivers and communities identified feasible solutions through co-creation workshops and this approach should be used whenever possible to inform local planning.

CONCLUSIONS

Policymakers and managers can integrate HCD and intersectionality mindsets into existing planning and assessment processes, and focus on overcoming root causes of sub-optimal implementation.

SARS CoV-2 Seroprevalence in Selected States of High and Low Disease Burden in Nigeria

IMPORTANCE

The global impact of COVID-19 has led to an increased need to continuously assess disease surveillance tools. The utility of SARS-CoV-2 serologic tools in determining immunity levels across different age groups and locations in helping to quickly assess the burden of COVID-19 with significant health policy implications is unknown.

OBJECTIVE

To determine the prevalence of SARS-CoV-2 antibodies with respect to the age group and sex of participants.

DESIGN, SETTING, AND PARTICIPANTS

A cross-sectional survey of 4904 individuals across 12 states with high and low COVID-19 disease burden in Nigeria was carried out between June 29 and August 21, 2021.

MAIN OUTCOMES AND MEASURES

Enzyme-linked immunosorbent assay was used for the detection of specific SARS-CoV-2 immunoglobulin G and immunoglobulin M antibodies, such as the nucleocapsid protein-NCP and spike protein S1. Interviewer-administered questionnaires provided information on participants' history of disease and associated risk factors.

RESULTS

A total of 4904 individuals participated in the study (3033 were female [61.8%]; mean [SD] age, 26.7 [6.51] years). A high seroprevalence of SARS-CoV-2 (78.9%) was obtained. Seropositivity was consistent across the states surveyed, ranging from 69.8% in Lagos to 87.7% in Borno. There was no association between sex and seropositivity (female, 2414 [79.6%]; male, 1456 [77.8%]; P = .61); however, an association was noted between age and seropositivity, with the peak prevalence observed in participants aged 15 to 19 years (616 [83.6%]; P = .001). Similarly, loss of appetite (751 [82.3%]; P = .04) and smell (309 [84.4%]; P = .01) were associated with seropositivity.

CONCLUSIONS AND RELEVANCE

In this cross-sectional study, a high SARS-CoV-2 seroprevalence was obtained among the study population during the low level of vaccination at the time of the survey. Thus, there is a need for both an efficacy and antibody neutralization test study to ascertain the efficacy of the antibody detected and the potential for herd immunity in Nigeria.

Knowledge attitude and practice about breast cancer among civil servants in Benin City, Nigeria

BACKGROUND

Breast cancer is often associated with severe morbidity and mortality especially when the patients present late. A major reason why patients present late is the lack of awareness about breast cancer, its complications and the management.

METHODS

The study was carried out using a structured questionnaire. A total of 400 female civil servants were enlisted in the study, but only 385 respondents completed and returned the forms.

RESULTS

Two hundred and seventy seven (72.0%) respondents had tertiary level of education. Sixty six (17.1%) respondents were in the 30-34-year age group. Three hundred and twelve (81.0%) respondents knew correctly that breast lump is usually the first symptom of presentation of breast cancer. One hundred and forty four (37.5%) respondents knew that a positive family history of breast cancer is a risk factor, while two hundred and seventy four (71.2%) respondents answered that cancer of one breast in a woman increases her chances of having cancer of the other breast. Three hundred and twenty one (83.4%) respondents knew that breast cancer could spread from one breast to the other and two hundred and thirty (59.7%) knew that breast cancer could spread to other parts of the body. One hundred and eighty three (47.5%) respondents would visit the hospital as the first reaction if they were to detect a breast lump, while twenty three (6.0%) respondents would ignore the lump. While three hundred and twenty seven (85.0%) respondents have heard of breast self- examination, only one hundred (26.0%) could correctly describe the procedure of breast self -examination. While one hundred and thirty five (35.0%) respondents have heard of mammography, only twenty seven (7%) respondents go for yearly mammography screening. Three hundred and seventy two (96.6%) respondents know that mastectomy is done as part of the management of breast cancer, but only forty nine (12.7%) respondents have heard about conservative surgery.

CONCLUSION

The level of awareness about breast cancer among civil servants in Benin City is low. There is the need to organize series of health education programs to enlighten the women about breast cancer. This can be done by government agencies or the non-governmental organizations. If properly executed, it may influence the attitude of women in Benin City about breast diseases and encourage early presentation to the hospital.

Prevalence of pterygium and pingueculum among motorcyclists in Nigeria

OBJECTIVES

To find out the prevalence of pingueculum and pterygium among commercial motorcyclists in Benin City, Nigeria and to note any associated or risk factors.

DESIGN

A prospective, cross sectional, case control study.

SETTING

A local Government Area (Oredo) and University of Benin Teaching Hospital, Benin City, Nigeria.

SUBJECTS

One hundred and forty four commercial male motorcyclists in motorcycle parks in the local Government area and a control group of 114 male indoor workers.

MAIN OUTCOME MEASURES

Presence of pterygium or pingueculum.

RESULTS

One hundred and forty four male motorcyclists formed the subjects of this study. The age range was 18 to 65 years with a mean age of 34.9 +/- 8.0 years. The total number of motorcyclists with pingueculum was 37 with 26 bilateral cases, 63 eyes were involved. The prevalence rate was 25.7%. Pterygium was present in 18 patients including 12 bilateral cases making a total of 30 eyes. The prevalence rate was 12.5% The total number of indoor workers with pingueculum was 24 and it was present in 46 eyes. The prevalence rate was 21.05%. Pterygium was present in 12 eyes of nine persons in the control group and the prevalence rate was 7.9%. There was no association between the duration of work as a commercial motor cyclist and the presence of a pterygium or a pingueculum. The usage of a hat/cap was found to have a protective effect as motorcyclists who do not wear hats are more likely to develop pingueculum than those who wear them. The use of glasses and hats together was found to be protective against the development of pingueculum and pterygium in this study.

CONCLUSION

The prevalence rate of 12.5% of pterygium and 25.7% of pingueculum in commercial motorcyclists in this study is quite high when compared with that of the controls. The wearing of face caps/hats was found to have a protective effect. They should be educated about the importance of wearing protective goggles and caps/brimmed hats.

Current practices and medico-legal aspects of pre-operative consent

BACKGROUND

Written informed consent is a pre requisite for surgical intervention as it provides the forum for the patient to appreciate implications of the procedure and the doctor to explain details and effects of the surgery.

OBJECTIVES

To evaluate the practice of obtaining informed consent pre-operatively by surgeons in Benin City and proffer solutions that would enhance its practice.

DESIGN

Cross-sectional study involving surgical patients or their relations or gurdian (in cases involving minors and unconscious patients) who were interviewed with structured ended questionnaires.

SETTING

Study was carried out at the University of Benin Teaching Hospital, Benin City, between 5th July and 6th September 2002.

RESULTS

One hundred and thirty-three respondents; 53(39.2%) males and 80(60.2%) females were interviewed. Documentations regarding consent were noted in 118(88.7%) cases. Of these, 74.6% felt they had enough time to reflect on the consent obtained while 48(36.1%) respondents were meeting the individual who obtained their consent for the first time. The content of information offered patients prior to obtaining consent was found to be significantly related to the levels of education (X2= 31.44; P<0.001). Over a hundred respondents were not informed of risk of procedure. Nonetheless over 50% of respondents felt satisfied with information supplied.

CONCLUSION

The quality of consent obtained from the average patient fell below expected standard. There is need for greater awareness amongst administrators of consent on the essence of improving quality of information given and mode of obtaining consent from patients.

Sociocultural aspects of haemorrhage in pregnancy

The knowledge, attitudes and practices of rural women in southern Nigeria are at least as important as the availability of modern obstetric care in the fight against haemorrhage in pregnancy. Community-based interventions taking this into account are necessary if the considerable mortality associated with the condition is to be significantly reduced.

Improving obstetric care at the district hospital, Ekpoma, Nigeria. The Benin PMM Team

PRELIMINARY STUDIES

Facility reviews and focus group discussions revealed several factors at the district hospital contributing to maternal deaths in Ekpoma District, Nigeria.

INTERVENTIONS

In response, the necessary equipment for the operating theater, labor suite and laboratory were repaired or purchased. A blood bank and standby generator were repaired. Drugs and consumable material were purchased and a revolving fund established. Refresher courses were held for medical officers, nursing staff and laboratory technicians. At a later stage, community interventions focused on improving access and reducing delay in seeking care.

RESULTS

The number of cesarean sections performed increased from zero in 1990-1991 to between seven and 13/year in the period 1992-1995. The number of women with major obstetric complications seen at the hospital increased from seven in 1990 (5% of obstetric admissions) to a high of 29 (20% of obstetric admissions) in 1993. These gains were not sustained, however. In 1995, only 12 women with complications (9% of obstetric admissions) were seen.

COSTS

The cost of improvements was approximately US $12,800, of which 41% was paid by the government and the rest by the project.

CONCLUSIONS

Improving obstetric care at the district hospital can increase use by women with complications. However, sociopolitical and economic problems can hamper success.

Emergency loan funds to improve access to obstetric care in Ekpoma, Nigeria. The Benin PMM Team

PRELIMINARY STUDIES

Focus group discussions in the community identified difficulties in paying for transport as a major barrier to seeking and reaching emergency care for obstetric complications.

INTERVENTIONS

After emergency obstetric services in local health facilities had been upgraded, the clans in Ekpoma were mobilized in 1995 to set up emergency loan funds for women with complications. Funds were managed entirely by the clans, with ongoing monitoring and supervision by project staff. Two percent simple interest was charged.

RESULTS

Of the 13 clans contacted, 12 successfully launched loan funds. Total donations amounted to US$793, of which four-fifths were contributed by the community. In the 1st year of the operation, 456 women/families requested loans (ranging from US$7 to US$15), and 380 (83%) were granted. Three-hundred and fifty-four (93%) loans were repaid in full. In addition to being used for transport, loans were used to help pay for drugs, blood and hospital fees.

COSTS

The cost of establishing the loan fund was US$1360, including initial donations to the loan funds. The PMM project paid 55% of the total.

CONCLUSIONS

With relatively little outside financial input, communities can set up and administer loan funds for emergency obstetric transport and care. However, sustaining the funds over the long term requires continuing effort and involvement with the communities.

Schistosoma haematobium in rural school children in Nigeria

A survey of Schistosoma haematobium infection was carried out in 722 rural school children in Emu, Edo State of Nigeria. The ages of the children ranged from 5-19 years with those between the age-group 10-14 years constituting the highest percentage 317 (43.9%). There were more males 383 (53.0%) than females 339 (47.0%) in the study population. Urine analysis of these children showed that 254 (35.2%) of them were excreting Schistosoma haematobium ova and of these 196 (27.2%) had haematuria. The prevalence of the disease was highest in the younger children with 43.1% for haematuria and 55.3% for S. haematobium ova among the age-group 5-9 years. The corresponding figures were 21.4% and 24.7% for age-group 10-14 years and 14.9% and 27.7% for 15-19 years old children. The sex-specific prevalences of haematuria and Schistosoma haematobium ova were higher for females than for the males.