Nigeria's 2025 PEPFAR funding suspension served as an unplanned natural experiment, uniquely demonstrating that behavioral instability among patients and providers precedes, and is in many respects more disruptive than, actual commodity shortages. This distinction, rarely documented in prior literature, has direct implications for how HIV program resilience should be designed and measured. We conducted in-depth key informant interviews with 15 healthcare providers at a major antiretroviral therapy (ART) facility in northern Nigeria, analyzed using Braun and Clarke's reflexive thematic analysis framework. Despite stable antiretroviral drug stocks, acute uncertainty triggered panic-driven patient visits, rumor-driven information gaps, and precautionary dispensing restrictions. Laboratory services deteriorated rapidly, and implementing partner staff worked without pay for up to two months, temporarily masking systemic fragility. Persistent structural barriers, transport costs, stigma, and treatment fatigue impeded adherence, independent of funding status. Providers distinguished technical capacity, which they judged sufficient, from political will, which they found lacking; transition structures existed but remained unimplemented. Sustaining ART delivery requires proactive crisis communication, protected multi-month dispensing, resilient laboratory financing, and governance reforms to reduce donor dependence. Political commitment is the central determinant of sustainable domestic HIV program ownership in Nigeria.

Background and Objective:Human immunodeficiency virus (HIV) is a major public health concern among pregnant women in Nigeria, with seven in every hundred women likely to have an HIV infection. Understanding factors associated with HIV infection among pregnant women is critical to improving prevention strategies, especially in conflict regions. This study investigates demographic, socio-economic, and behavioral determinants of HIV among pregnant women in Nigeria, with conflict exposure included as a key predictor in the analysis. Methods:This study is a cross-sectional design using data from the 2018 Nigeria HIV/Acquired Immunodeficiency Syndrome (AIDS) Indicator and Impact Survey, the largest population-based HIV survey globally, implemented between July and December 2018 across all 36 states and the Federal Capital Territory of Nigeria. We analyzed weighted data from 3,879,192 pregnant women (both HIV-positive and negative), conducting bivariate and multivariate analyses to identify predictors of HIV infection among women aged 15-49 years while adjusting for potential confounders. Adjusted Odds Ratios (AORs) with 95% confidence intervals (CIs) were generated using unconditional logistic regression models to determine significant predictors. Results:Our analysis revealed that women in conflict zones were younger, less educated, and more likely to be in polygynous marriages and the lowest wealth quintile compared to those in non-conflict zones. In a multivariable analysis, residence in a conflict zone was associated with nearly twofold adjusted odds of HIV positivity (AOR = 1.93; CI: 0.98-3.82; p = 0.057). Increasing maternal age (AOR = 1.06; CI: 1.02-1.10; p = 0.002) and middle to fourth wealth quintile status (AOR = 4.10 and 3.80, respectively; p < 0.05) were significantly associated with a higher likelihood of HIV infection. Recent non-marital sexual activity was also significantly associated with HIV positivity (AOR = 2.96; p = 0.037). Conclusion and Global Health Implications:The study identifies conflict exposure and socio-economic status as significant predictors of HIV infection among pregnant women in Nigeria. Our analysis reveals important demographic, socio-economic, and behavioral factors associated with HIV prevalence in this population. These findings underscore the need for comprehensive HIV prevention strategies that address the complex interplay of social determinants, particularly in vulnerable populations.

Background Tuberculosis (TB) remains a leading cause of morbidity and mortality in Nigeria, particularly among people living with HIV (PLWH), who face significantly higher risks of developing active TB. Conventional diagnostic methods such as sputum smear microscopy and chest radiography often fail to detect TB accurately in this population due to smear-negative presentations and atypical radiographic findings. Recent diagnostic innovations, including the Xpert MTB/RIF Ultra, TB lipoarabinomannan (TB-LAM) and TB loop-mediated isothermal amplification (TB-LAMP) tests, offer improved sensitivity and specificity, but their cost-effectiveness in resource-limited settings remains unclear.Methods In this economic evaluation, we combined a decision tree with cost-effectiveness analysis to compare three TB diagnostic algorithms tailored for PLWH in Nigeria: (1) Xpert MTB/RIF Ultra following chest radiography (chest X-ray; CXR), (2) TB-LAM following CXR and (3) TB-LAMP following CXR. Data on test accuracy, costs and TB prevalence were obtained from systematic reviews and meta-analyses, with costs adjusted for inflation and local purchasing power. We estimated the incremental cost-effectiveness ratios (ICERs) for the three diagnostic approaches. Sensitivity analyses were conducted to assess the robustness of results across varying input parameters.Results TB/LAM was found to be the most cost-effective option at a cost of US$17 per TB case detected when compared with US$20 and US$22 per TB case detected for the baseline strategy of Xpert MTB/RIF Ultra and TB-LAMP, respectively. These ICERs are consistent with willingness-to-pay thresholds set at three times Nigeria’s gross domestic product (GDP) and remained robust over a wide range of costs and epidemiological parameter inputs.Conclusion Among PLWH in Nigeria, the TB-LAM algorithm represents the most cost-effective diagnostic strategy. However, the Xpert MTB/RIF Ultra may provide additional value in settings with sufficient infrastructure and funding. This study underscores the need for tailored diagnostic approaches that balance accuracy, scalability and affordability to enhance TB detection and management in vulnerable populations.

Background There is a dearth of information regarding mpox risk perception and vaccine acceptance among people living with human immunodeficiency virus (HIV), especially in countries with a dual burden of HIV and mpox, such as Nigeria.Methods We used an explanatory mixed methods design and structured questionnaires administered to a clinic-based sample of people living with HIV (n=430), followed by in-depth interviews with a purposive subsample (n=20). Data were analysed using binary logistic regression and the framework approach.Results More than one-third (38.1% [n=164]) of the respondents self-perceived a high risk of mpox and 64.4% (n=277) indicated a willingness to receive the vaccine. Willingness to accept the mpox vaccine was positively associated with male sex, older age, non-Muslim faith, unmarried status, post-secondary education and current civil service employment. The odds of accepting the mpox vaccine was also higher among respondents who perceived mpox as a serious disease (adjusted odds ratio [aOR] 1.41 [95% confidence interval {CI} 1.12 to 2.35]), self-assessed a higher risk (aOR 1.66 [95% CI 1.19 to 3.06]) and were concerned about contracting the disease (aOR 1.78 [95% CI 1.12 to 3.94]). Reasons for hesitancy included anxiety about vaccine-antiretroviral drug interactions, low risk perception, perceived protection from antiretroviral treatment, the newness of the vaccine, mistrust of authorities and pharmaceutical companies and concerns regarding vaccine safety.Conclusions Mpox risk perception and vaccine acceptance were suboptimal. Vaccine acceptance was influenced by sociodemographic, perceived susceptibility and health behaviour-related factors. Targeted risk communication will enhance acceptance of mpox vaccination among people living with HIV in Nigeria.

Sickle cell anemia (SCA) remains a critical global health challenge, disproportionately affecting sub-Saharan Africa, India, and the Middle East. It significantly impacts the quality of life of affected children, with malnutrition further exacerbating the disease severity and increasing the risk of hospitalization and death. This study aims to explore the socioeconomic and clinical risk factors driving malnutrition in this vulnerable population. A cross-sectional study was conducted among children with sickle cell disease attending the outpatient clinic of Murtala Muhammad Specialist Hospital in Kano, Nigeria. Simple random sampling was used to select participants. Anthropometric measurements were used to calculate weight for height z score, classifying malnutrition based on the World Health Organization standards. Multivariable logistic regression was employed to identify factors associated with malnutrition, with sub-analysis focusing on severe acute malnutrition in children with SCA. A total of 561 children with SCA participated in the study, with 141 (25.1%) under-five and 420 (74.9%) older children aged 5–12 years. Severe acute malnutrition was more prevalent among older children (16.5%) compared to children under 5 years (13.6%) with SCA. Multivariable analysis showed that for each additional year, an increase in age, the likelihood of severe acute malnutrition among SCA children increased by 13% (adjusted odds ratio: 1.13, confidence interval: 1.04, 1.24, p = 0.004). The study highlighted significant age-related differences in the nutritional status of children with SCA. It also highlights the need for targeted nutritional interventions and care approaches to address malnutrition among older children with SCA.

Brain drain represents an existential threat to the health ecosystem in Nigeria as an increasing number of health professionals migrate to developed and industrialized nations where they are guaranteed higher salaries, better job security, and a more conducive work environment. As of 2023, the United Kingdom remains the leading destination, with over 12,000 Nigerian doctors, while the United States, Canada, and Germany follow closely. While these migrations provide individual doctors with career advancement and financial security, they leave behind a healthcare system teetering on the edge. The shortage of healthcare professionals is already having profound effects on Nigeria's health indices, including a staggering burden of maternal-infant morbidity and mortality. The solution to this medical "tsunami" consists of improving the welfare of healthcare workers, creating more job opportunities, and investing in modern healthcare infrastructure. Ultimately, sound political and visionary leadership is required for any lasting solution to the current healthcare brain drain, which threatens health security in Nigeria.

Postpartum hemorrhage (PPH), defined as a blood loss of 500 mL or more within 24 hours after birth, remains the leading cause of maternal mortality globally, accounting for over 20% of all maternal deaths. The burden of mortality from PPH is predominantly in low- and middle-income countries and demands coordinated accelerated efforts from the global maternal health community to meet the Sustainable Development 3 maternal health target by 2030. The International Journal of Maternal and Child Health and AIDS and the Concept Foundation are proud to present this Special Collection demonstrating the evidence for introducing heat-stable carbetocin and tranexamic acid, showcasing the feasibility and acceptability of their utilization for PPH prevention and management in resource-limited high-burden settings.

Limited literature exists on men’s experiences with intimate partner violence (IPV) during the COVID-19 lockdown, especially in resource-constrained settings such as Nigeria. We investigated the prevalence, risk factors, and lifetime experiences of IPV among men in Nigeria during COVID-19 restrictions. Using a mixed methods design, we interviewed 420 married men with a structured questionnaire and conducted 20 in-depth interviews. Logistic regression and a framework approach were used for data analysis. Approximately 86.4

BackgroundCoronavirus disease 2019 (COVID-19) has emerged as an important cause of morbidity and mortality worldwide. The aim of this study is to identify the clinical predictors of mortality among patients with COVID-19 pneumonia during first and second waves in a treatment center in northwestern Nigeria.MethodsThis was a retrospective cohort study of 195 patients hospitalized with COVID-19 between April 2020 to March 2021 at a designated COVID-19 isolation center in Kano State, Northwest Nigeria. Data were summarized using frequencies and percentages. Unadjusted odds ratios and 95% confidence intervals and p-values were obtained. To determine independent determinants of mortality, we performed a stepwise multivariate logistic regression model.ResultsOf 195 patients studied, 21(10.77%) patients died. Males comprised 158 (81.03%) of the study population. In the adjusted stepwise logistic regression analysis, age>64 years (OR = 9.476, 95% CI: 2.181-41.165), second wave of the pandemic (OR = 49.340, 95% CI:6.222-391.247), cardiac complications (OR = 24.984, 95% CI: 3.618-172.508), hypertension (OR = 5.831, 95% CI:1.413-24.065) and lowest systolic blood pressure while on admission greater than or equal to 90mmHg were independent predictors of mortality (OR = 0.111, 95%CI: 0.021-0.581).ConclusionStrategies targeted to prioritize needed care to patients with identified factors that predict mortality might improve patient outcome.

BACKGROUND:The Malaria Frontline Project (MFP) supported the National Malaria Elimination Program for effective program implementation in the high malaria-burden states of Kano and Zamfara adapting the National Stop Transmission of Polio (NSTOP) program elimination strategies.PROJECT IMPLEMENTATION:The MFP was implemented in 34 LGAs in the two states (20 out of 44 in Kano and all 14 in Zamfara). MFP developed training materials and job aids tailored to expected service delivery for primary and district health facilities and strengthened supportive supervision. Pre- and post-implementation assessments of intervention impacts were conducted in both states.RESULTS:A total of 158 (Kano:83; Zamfara:75) and 180 (Kano:100; Zamfara:80) healthcare workers (HCWs), were interviewed for pre-and post-implementation assessments, respectively. The proportions of HCWs with correct knowledge on diagnostic criteria were Kano: 97.5% to 92.0% and Zamfara: 94.7% to 98.8%; and knowledge of recommended first line treatment of uncomplicated malaria were Kano: 68.7% to 76.0% and Zamfara: 69.3% to 65.0%. The proportion of HCWs who adhered to national guidelines for malaria diagnosis and treatment increased in both states (Kano: 36.1% to 73.0%; Zamfara: 39.2% to 67.5%) and HCW knowledge to confirm malaria diagnosis slightly decreased in Kano State but increased in Zamfara State (Kano: 97.5% to 92.0%; Zamfara: 94.8% to 98.8%). HCWs knowledge of correct IPTp drug increased in both states (Kano: 81.9% to 94.0%; Zamfara: 85.3% to 97.5%).CONCLUSION:MFP was successfully implemented using tailored training materials, job aids, supportive supervision, and data use. The project strategy can likely be adapted to improve the effectiveness of malaria program implementation in other Nigerian states, and other malaria endemic countries.

Background and Objective:The COVID-19 pandemic response overwhelmed health systems, disrupting other services, including maternal health services. The disruptive effects on the utilization of maternal health services in low-resource settings, including Nigeria have not been well documented. We assessed maternal health service utilization, predictors, and childbirth experiences amidst COVID-19 restrictions in a rural community of Kumbotso, Kano State, in northern Nigeria.Methods:Using an explanatory mixed methods design, 389 mothers were surveyed in January 2022 using validated interviewer-administered questionnaires, followed by in-depth interviews with a sub-sample (n=20). Data were analyzed using logistic regression models and the framework approach.Results:Less than one-half (n=165, 42.4%) of women utilized maternal health services during the period of COVID-19 restrictions compared with nearly two-thirds (n=237, 65.8%) prior to the period (p<0.05). Non-utilization was mainly due to fear of contracting COVID-19 (n=122, 54.5%), clinic overcrowding (n=43, 19.2%), transportation challenges (n=34, 15.2%), and harassment by security personnel (n=24, 10.7%). The utilization of maternal health services was associated with participant's post-secondary education (aOR=2.06, 95% CI:1.14- 11.40) (p=0.02), and employment type (civil service, aOR=4.60, 95% CI: 1.17-19.74) (p<0.001), business aOR=1.94, 95% CI:1.19- 4.12) (p=0.032) and trading aOR=1.62, 95% CI:1.19-2.94) (p=0.04)). Women with higher household monthly income (≥ N30,000, equivalent to 60 US Dollars) (aOR=1.53, 95% CI:1.13-2.65) (p=0.037), who adhered to COVID-19 preventive measures and utilized maternal health services before the COVID-19 pandemic were more likely to utilize those services during the COVID-19 restrictions. In contrast, mothers of higher parity (≥5 births) were less likely to use maternal health services during the lockdown (aOR=0.30, 95% CI:0.10-0.86) (p=0.03). Utilization of maternal services was also associated with partner education and employment type.Conclusion and Global Health Implications:The utilization of maternal health services declined during the COVID-19 restrictions. Utilization was hindered by fear of contracting COVID-19, transport challenges, and harassment by security personnel. Maternal and partner characteristics, adherence to COVID-19 preventive measures, and pre-COVID maternity service utilization influenced attendance. There is a need to build resilient health systems and contingent alternative service delivery models for future pandemics.

Introduction: Telemedicine practice experiences during the COVID-19 pandemic have not been well documented in resource-constrained settings, such as Nigeria. We set out to assess knowledge, attitude, and factors associated with telemedicine practice during the COVID-19 lockdown, as well as physician experiences in Kano, Nigeria. Methods: We employed a mixed-methods approach, utilizing structured questionnaires administered to 246 physicians, followed by in-depth interviews with a purposive subsample of 20 individuals. The data were analyzed using logistic regression and the framework approach. Results: Overall, 65.0% of the respondents demonstrated moderate to good knowledge of telemedicine. Before COVID, only 47.6% (n = 117) reported practicing telemedicine, compared with 77.2% (n = 190) during the COVID lockdown (p < 0.05). Factors associated with telemedicine practice included having at least 5 years of work experience, working in pediatrics, undergoing senior residency training, receiving formal telemedicine training, possessing good knowledge of telemedicine, and having a positive attitude toward it. The odds of engaging in telemedicine practice were four times higher (adjusted odds ratio = 4.10, 95% confidence interval: 1.79-9.40) for those who practiced it before the pandemic. Challenges identified included knowledge and skill gaps, slow internet connectivity, unstable electricity, and inadequate equipment. Conclusion: To enhance telemedicine practice in resource-limited settings, it is important to focus on strengthening information and communication infrastructure, providing comprehensive clinician training, implementing careful patient selection processes, and improving practice guidelines.

The U.S. Centers for Disease Control and Prevention in collaboration with the National Malaria Elimination Program and the African Field Epidemiology Network established the Malaria Frontline Project to provide innovative approaches to improve the malaria program implementation in Kano and Zamfara States, Nigeria. Innovative approaches such as malaria bulletin, malaria monitoring wall chart, conduct of ward level data validation meetings and malaria dashboard have helped improve the use of data for decision making at all levels. Innovative approaches deployed during the project implementation facilitated data analysis and a better understanding of malaria program performance and data utilization for decision making at all levels. These innovative approaches may improve malaria control program performance in Nigeria and other resource limited countries.

This study examined the support for vaccine mandates and uptake among clinical and non-clinical staff at a tertiary hospital in northern Nigeria, focusing on variation of survey responses based on job position, socio-demographic characteristics, and perceived risk of infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Using an explanatory, sequential, mixed-methods design and deploying a pragmatic paradigm, 370 healthcare workers were administered structured questionnaires. This was followed by in-depth interviews with a sub-sample of respondents to further clarify the responses regarding support for the coronavirus disease 2019 (COVID-19) vaccine mandate. Findings demonstrated that less than one-half of respondents supported the COVID-19 mandate, and only one in three had received the recommended COVID-19 vaccine doses. Support for the vaccine mandate and vaccine uptake were predicted by profession, work experience, number of children, health status, and risk perception. Support for the vaccine mandate was ascribed to ethical and professional duty, whereas opposition was associated with respect for autonomy and human rights. This study documents the need to enhance support for vaccine mandates and uptake among healthcare workers through sustainable strategies, as Nigeria's healthcare workers are considered a source of trust and role models for the rest of society.

Community mobilization, partnership, and surveillance are regarded as key elements in various polio eradication activities. Several nongovernmental organizations have led community mobilizers (CMs) in different aspects of the polio eradication campaigns, and their effectiveness shows mixed findings. This study systematically reviewed the literature on the role of CMs in polio eradication activities. Literature searches were conducted using a combination of key words to find relevant published studies up to 30 November 2020. The 27-item Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist addressing the various components of systematic review was adhered to. A total of 1627 articles were identified by the search, with 65 articles passing the title/abstract and full text reviews, and with four additional articles obtained from references of articles included (making a total of 69 articles). Of these 69 articles involved in the review, 24 (five reviews and 19 original articles) focused largely and explicitly on CMs and were included in the full review. The rest (45) discussed CMs in a broader context, hence they were summarized based on part 1 of the data extraction form only.The findings of the review indicated that although CMs’ instrumental role in health promotion and supporting immunization is consistent for all the reviewed studies, their role in acute flaccid paralysis (AFP) case detection is limited. The role of CMs, other actors in community-based surveillance, and health education needs to be further strengthened, particularly in high-risk communities where routine immunization and AFP surveillance are much needed.

Increasing vaccine uptake among pregnant women is a critical part of combating the coronavirus disease 2019 (COVID-19) pandemic.1Shook L.L. Fallah P.N. Silberman J.N. et al.COVID-19 vaccination in pregnancy and lactation: current research and gaps in understanding.Front Cell Infect Microbiol. 2021; 11: 735394Google Scholar The prevalence and correlates of vaccine acceptance among pregnant women in Nigeria are unknown. We assessed acceptability and correlates of COVID-19 vaccines among pregnant women attending an antenatal clinic in Nigeria. The study was conducted at Aminu Kano Teaching Hospital in Nigeria, a 750-bed referral facility serving ∼13 million people. Systematic sampling was used to recruit consenting pregnant women upon arrival for antenatal care (n = 420). Quantitative data were collected using an adapted, interviewer-administered, structured questionnaire.2Freeman D. Loe B.S. Chadwick A. COVID-19 vaccine hesitancy in the UK: the Oxford coronavirus explanations, attitudes, and narratives survey (Oceans) II.Psychol Med. 2021; : 1-15Google Scholar,3Schwarzinger M. Watson V. Arwidson P. et al.COVID-19 vaccine hesitancy in a representative working-age population in France: a survey experiment based on vaccine characteristics.Lancet Public Health. 2021; 6: e210-e221Google Scholar A variable representing vaccine acceptability was created based on a 5-point Likert scale (very keen = 1 to against it = 5). Vaccine acceptability was defined as “yes” if a respondent answered “very keen” or “pretty positive” and “no” for any other response. Multivariable logistic regression was employed to assess factors independently associated with vaccine acceptability. Adjusted odds ratios and 95% confidence intervals were computed. Hosmer-Lemeshow statistic and omnibus tests were used to determine model fitness. Among the 420 pregnant women invited to participate, 399 (95.0%) completed the survey-based interview. The median gestational age of respondents was 32 weeks (interquartile range: 24–36). Among respondents, 359 (90.0%) were of Hausa-Fulani ethnicity, 373 (93.5%) were Muslim, 280 (70.2%) had two or more children, and 356 (89.2%) had completed at least secondary education. Most (312 [78.2%]) had received at least one dose of tetanus toxoid during the current pregnancy. Overall, 283 respondents (70.9%) thought that pregnant women affected by COVID-19 could become very sick. Similarly, 296 respondents (74.2%) were worried about the effects of COVID-19 on their unborn babies. However, only 74 respondents (18.6%) considered themselves to be at high risk for COVID-19 infection. In terms of protection, 236 respondents (59.1%) thought that COVID-19 vaccination could reduce their risk of contracting COVID-19, and 222 (55.6%) believed that the vaccine would reduce risk for the unborn baby. Most respondents were worried about vaccine side effects, efficacy, and safety. For example, 339 (85.0%) and 360 (90.2%) were worried about safety and side effects, respectively. Additionally, 149 (37.3%) were concerned about infertility-related rumors. Half of the respondents (200 [50.1%]) reported that they would consider vaccination if recommended by their doctor. However, only 135 respondents (33.8%) would accept the COVID-19 vaccine during pregnancy. One-quarter (106 [26.6%]) reported that they would only take it after delivery, and 93 (23.3%) would delay vaccination until after weaning the baby off breast milk. The respondent’s religion, number of living children, education, income, gestational age at booking, self-assessed health status, risk perception, and vaccine safety concerns were independently associated with COVID-19 vaccine acceptability (Table, Appendix). For example, non-Muslim respondents had a four-fold increased likelihood of accepting the vaccine during pregnancy. Similarly, respondents with primary education were 6 times more likely to accept the vaccine. Furthermore, primigravid women and those who booked early (≤12 weeks gestational age) for antenatal care had 3-fold increased odds of accepting COVID-19 vaccination during pregnancy. Women who received tetanus toxoid in the current pregnancy and those who self-assessed their health status as “good” or “very good” had at least a 4-fold increased likelihood of accepting the COVID-19 vaccine. Finally, pregnant women who were not concerned about COVID-19 vaccine safety were 8 times more likely to accept the vaccine. In conclusion, we found low COVID-19 vaccine acceptance among pregnant women seeking antenatal care in Nigeria. Vaccine acceptability was associated with several sociodemographic and health-related factors. Our findings present an opportunity for public health action to reduce misconceptions about the COVID-19 vaccine. Our results will inform the design of interventions to build trust and boost COVID-19 vaccine confidence among pregnant women in similar settings. Supplemental TableLogistic regression model for predictors of acceptability of COVID-19 vaccination among pregnant women attending AKTH, Kano, Nigeria (n = 399)AKTH: Aminu Kano Teaching Hospital; COVID-19: coronavirus disease 2019; OR: odds ratio.CharacteristicsAdjusted OR (95% CI)P valueReligion IslamReferent Christianity4.08 (1.53–10.91)0.007aSignificant at P < 0.05Education Less than primaryReferent Completed primary6.21 (1.08–35.69)0.011aSignificant at P < 0.05 Completed secondary or more1.46 (0.33–6.39)0.69Monthly income (Naira) <30 000Referent ≥30 0001.76 (1.14–3.26)0.034aSignificant at P < 0.05Number of living children 02.88 (1.13–7.34)0.018aSignificant at P < 0.05 11.19 (0.58–2.42)0.74 2–41.24 (0.54–2.84)0.97 ≥5ReferentGestational age at booking, wk ≤123.00 (1.71–5.27)0.002aSignificant at P < 0.05 23–28ReferentCurrent gestational age, wk 13–281.46 (0.82–2.63)0.20 29–40ReferentTetanus toxoid immunization in current pregnancy Yes6.90 (2.70–17.63)<0.001aSignificant at P < 0.05 NoReferentSelf-assessed health status Very good5.15 (1.65–16.07)<0.001aSignificant at P < 0.05 Good4.04 (2.34–7.01)0.007aSignificant at P < 0.05 FairReferentCOVID-19 risk perception High1.24 (1.07–2.74)0.037aSignificant at P < 0.05 LowReferentConcerned about COVID-19 vaccine safety YesReferent No8.30 (4.41–15.62)0.007aSignificant at P < 0.05Concerned about COVID-19 vaccine efficacy YesReferent No1.41 (0.41–4.87)0.59Concerned about side effects of COVID-19 vaccine YesReferent No1.70 (0.43–6.77)0.45Hosmer-Lemeshow chi-square = 5.63; P = 0.73. Models adjusted for age.a Significant at P < 0.05 Open table in a new tab Hosmer-Lemeshow chi-square = 5.63; P = 0.73. Models adjusted for age.

Objectives: We estimated the length-of-stay (LOS) in the health facility after childbirth and identified associated factors in three sub-Saharan African countries.Design: Secondary analysis using data from the most recent Multiple Indicator Cluster Surveys.Setting: Multiple Indicator Cluster Surveys from Ghana, Malawi and Eswatini were selected.Participants: Women aged 15-49 years who had a facility delivery in the two years preceding the survey were in-cluded.Main outcome measures: Length-of-stay recorded in days and weeks were converted to hours and analysed as a continuous variable.Results: Length-of-stay was estimated for 9147 women, wherein 6610 women (median LOS and IQR: 36 36,60 hours), 1698 women (median LOS and IQR 36 10,60 hours) and 839 women (median-length-stay 36 36,60 hours) were from Malawi, Ghana and Eswatini respectively. Being from Ghana [RC, -20.6 (95%CI:-25.2 - -16.0)] and then Eswatini [RC: -13.0 (95%CI: -19.9 - -9.8)] and delivery in a government hospital [RC: -4.9 (95%CI -9.9- -0.3)] were independently associated with having a shorter LOS. Having a caesarean section, assistance by Nurses/Mid-wives or Auxiliaries/CHOs, single birth, heavier birth weight, and death of newborn before discharge increased the duration of stay.Conclusions: Necessitating and facility factors are important determinants of length of stay. Socio-demographic characteristics, however, have a restricted role in influencing the duration of postpartum stay in sub-Saharan Africa. Further prospective research is required to identify more determinants and provide evidence for policy formulation and clinical guidelines regarding the safest time for discharge after delivery.

Prior to its planned introduction, we investigated predictors of baseline knowledge and acceptability of HPV vaccination among medical and allied health care students in Kano, northern Nigeria. A total of 410 medical, dental and allied health students completed structured validated questionnaires. Knowledge scores and acceptability of HPV vaccine were determined and adjusted odds ratios (AOR) for predictors of HPV knowledge and acceptability were derived from multivariate logistic regression models. Overall, 3.7% (n = 15), 30.7% (n = 126) and 65.6% (n = 269) of respondents had good, moderate, and poor knowledge of HPV, respectively. The majority 334 (81.5%) were willing to accept the HPV vaccine, but only 18 (4.4%) had received at least one dose of the vaccine. Knowledge of HPV was better among females, younger (<20 years) medical students, students at higher levels of study, sexually experienced students, and condom users. HPV vaccine acceptance was higher among female students in the faculty of allied health with a family history of cervical cancer and good or moderate knowledge of HPV. In conclusion, most students were willing to receive HPV vaccination, despite their sub-optimal level of knowledge and low vaccine uptake. We recommend piloting the HPV vaccine in health colleges and recruiting early adopters as peer educators and advocates.IMPACT STATEMENTWhat is already known on this subject? Human Papilloma Virus (HPV) vaccine has been introduced in over 80 countries in the past decade, but evidence suggests low awareness of HPV infection and the vaccine, especially in developing countries. Nigeria proposes to introduce the HPV vaccine as part of the routine immunisation program in early 2021.What do the results of this study add? The majority of medical and allied health students in Kano, Nigeria, were willing to receive HPV vaccination, despite their sub-optimal level of knowledge and low vaccine uptake. Vaccine acceptance was predicted by the respondent's sex, course of study, family history of cervical cancer and knowledge of HPV.What are the implications of these findings for clinical practice and/or further research? The findings could inform program implementation and evaluation as HPV vaccine uptake is scaled up across Africa.

BACKGROUND:People living with HIV (PLHIV) are at increased risk of COVID-19 acquisition, severe disease, and poor outcomes. Yet, little is known about COVID-19 vaccine hesitancy among PLHIV in high HIV burden countries, such as Nigeria.OBJECTIVE:This study aims to assess the acceptability of the COVID-19 vaccine and identify predictors and reasons for vaccine hesitancy among patients living with HIV and attending a tertiary hospital in Kano, northern Nigeria.METHODS:Using a mixed-methods design, structured questionnaires were administered to a clinic- based sample of patients living with HIV (n = 344), followed by 20 in-depth interviews with a sub-sample. Logistic regression and the framework approach were used to analyze the data.RESULTS:Less than half (46.2 %, n = 159) of the respondents were willing to take the COVID-19 vaccine. Vaccine acceptance was higher among non-Muslim PLHIV (Adjusted Odds Ratio (aOR) = 1.26, 95 % Confidence Interval (95 % CI): 1.10-4.00), persons with high-risk perception (aOR = 2.43, 95 % CI:1.18-5.00), those who were not worried about infertility-related rumors (aOR = 13.54, 95 % CI:7.07-25.94) and persons who perceived antiretroviral drugs are protective against COVID-19 (aOR = 2.76, 95 % CI: 1.48-5.14). In contrast, vaccine acceptance was lower among persons who were not concerned about the potential effects of COVID-19-HIV co-infection (aOR = 0.20, 95 % CI:0.10-0.39). The most common reasons for vaccine hesitancy included doubts about the existence of COVID-19, low-risk perception, anxiety about antiretroviral treatmentvaccine interactions, safety concerns, and infertility-related rumors.CONCLUSION:Covid-19 vaccine acceptance was low among PLHIV. COVID-19 vaccine acceptance was associated with respondents' faith, risk perception, perception of the protective effects of antiretroviral treatment, concerns about COVID-19-HIV co-infection, and infertility-related rumors. Vaccination counseling should be integrated into HIV treatment services to improve COVID-19 vaccine uptake among PLHIV in Kano, Nigeria and similar settings.