SETTING: Despite recent progress in TB notification rates, 6.2% of the 3.1 million ‘missing’ people with TB globally are from Nigeria. Identifying these ‘missing’ cases will improve TB control efforts in Nigeria. OBJECTIVE: This paper aims to describe the outcome of an intensified TB case-finding strategy in northern Nigeria. DESIGN: An intensified TB case-finding strategy was implemented in four states in northern Nigeria from October 2021 to September 2022. Trained ad-hoc staff screened hospital attendees and linked identified persons with presumptive TB to diagnosis using a hub and spoke approach. People with confirmed TB were linked to treatment. Contributions of the strategy to the national TB notification rates for each state were assessed. RESULTS: A total of 1.17 million individuals were screened for TB across the four project States. 64,079 people with presumptive TB were identified, of which 10.1% were diagnosed with TB and 97% of those diagnosed were placed on treatment. Averagely, 33.3% of the TB cases notified from each state were contributions from the hospital-based Intensified TB case-finding intervention. CONCLUSION: Facility-based intensified TB case-finding results in significant improvement in TB notification rates and a good strategy to improve the identification of missing TB cases in Nigeria.

The phenotypic detection of Streptococcus pneumoniae in clinical samples, particularly those collected from infants, is vital for understanding its epidemiology and improving disease management. However, despite advancements in laboratory techniques, achieving optimal yield of Streptococcus pneumoniae remains a significant challenge. This paper explores the primary obstacles that compromise the effective recovery of Streptococcus pneumoniae from clinical samples and suggests potential strategies for improvement. One of the key issues identified are the effect of various sampling, transportation and storage techniques on the overall bacteria yield. Factors such as improper sample collection methods, inappropriate use or lack of use of transport media, and delays in processing can significantly diminish the viability of Streptococcus pneumoniae. In addition, the choice of culture media and conditions, while critical, may not always support the optimal growth of the bacterium, leading to false-negative results or underestimation of bacterial load. There is a need for a re-evaluation of current protocols, emphasizing the need for standardized procedures that are tailored to the specific requirements of pneumococcal detection. Further research into developing more resilient and specific culture media and better training for healthcare professionals involved in sample collection and processing should be encouraged. Addressing these challenges is crucial for improving diagnostic accuracy, guiding effective treatment strategies, and ultimately reducing the burden of pneumococcal disease.

Poultry farming practices can impact soil health by altering its microbial and organic composition. On one hand, this could improve soil fertility, but on the other, it may pose health risks to humans and the environment. In this study, we assessed the microbial community structure and composition of poultry litter impacted soil in poultry farms in Lagos Nigeria. Composite soil samples were collected from two farms (PF01A and PF02B) in a poultry estate and from a pristine environment (CTR) without farming activity. Metagenomic analysis was performed using 16S rRNA gene amplicon sequencing and bioinformatics analysis. The most abundant phyla in poultry-impacted soils were Firmicutes (54–69

BACKGROUND: Human activities in diverse sectors contribute to the surge of antimicrobial resistance. This study assessed wastewater and soil from selected environments in Lagos, Nigeria, for the presence of antibiotic-resistant bacteria (ARB), as well as their resistance genes. Lagos is a city with densely populated urban and slum settlements characterized by poor drainage systems into which waste effluents are emptied. This highlights Lagos as an ideal site for the study, as it could be an epicenter for the breeding and transmission of ARB. METHODS: A total of 12 samples, comprising four soil and eight water samples, were collected and analyzed from selected environments, including an abattoir, a tertiary hospital, a pharmaceutical company, and farms. The physicochemical parameters of the samples were characterized using standard protocols. Bacterial strains were isolated through culture, and antimicrobial resistance profiles were determined using the Kirby-Bauer method. Resistance genes were detected through specific primer-dependent real-time quantitative PCR, from the extracted genome. RESULTS: The physicochemical analyses of the wastewaters revealed higher biochemical oxygen demand (BOD: 326.7 +/- 4.51-821.0 +/- 2.0 mg/L), dissolved oxygen (DO: 1.05 +/- 0.07-4.27 +/- 0.14 mg/L), and total dissolved solids (TDS: 0.14 +/- 0.0-5.18 +/- 0.012 g/L) than the recommended limits. Soil samples contained total organic carbon, organic matter (OM), and phosphate, ranging from 0.14 (+/- 0.031)-9.77 (+/- 0.091), 0.24 (+/- 0.050)-16.90 (+/- 0.164), and 2.22 (+/- 0.046)-5.28 (+/- 0.308) mg/kg, respectively. Klebsiella pneumoniae (21.5%) predominated among the isolated bacteria, which also included Enterobacter spp., Providencia stuartii, Salmonella spp., Pseudomonas spp., and Vibrio parahaemolyticus. Enterobacter aerogenes isolated from abattoir effluents exhibited resistance to 7 antibiotics with a Multi-Antibiotic Resistance Index of 0.58. Thirty-four (52.3%) bacterial strains were resistant to pefloxacin. blaTEM resistance gene was detected in all (100%) samples with mean Ct values ranging from 15.60 +/- 0.12 to 27.93 +/- 0.06, while blaCMY and qnrS were detected in 58% and 83% of the samples respectively. CONCLUSIONS: This study reveals that effluents from the assessed environments are hotspots for the dissemination of antibiotic resistance within the ecosystem.

SETTING:TB screening cascade and performance of active case-finding strategies across six states of Nigeria. OBJECTIVE:To analyse the impact of portable digital X-ray (PDX) on TB screening in hard-to-reach areas in Nigeria. DESIGN:A cross-sectional study involving enrollees with a CAD4TB score of ≥50 had Xpert (sputum) and/or radiographic assessment for TB diagnosis. A TB screening algorithm guided the step-by-step process of identifying a presumptive TB client up to diagnosis and linkage for appropriate treatment. Data were collected, collated, and reported using the national TB tools. RESULTS:Seven PDX with CAD4TB used as TB screening and diagnostic tools across six states screened 85,910 persons and identified 8,416 presumptive TB cases. From this study, PDX had the lowest number needed to screen (NNS) of 45 and the number needed to test (NNT) of 4. Similarly, PDX, with a presumptive TB yield of 10%, had the highest TB yield of 23%. CONCLUSION:Using PDX with CAD contributed to the highest TB yield during Active TB case finding in hard-to-communities of Nigeria. With a very low NNS and NNT, its national scale-up and use across remote locations will significantly improve TB case-finding.

BackgroundDespite promising signs of the benefits associated with Antimicrobial Stewardship Programs (ASPs), there remains limited knowledge on how to implement ASPs in peculiar settings for a more elaborate impact. This study explored prescriber experiences and perceptions of the usefulness, and feasibility of strategies employed for the implementation of antimicrobial stewardship (AMS) interventions as well as challenges encountered.MethodsThis is a cross-sectional mixed-method survey of prescribers' perspective of the facilitators and barriers of implementing ASP. The quantitative approach comprised of a semi-structured questionnaire and data collected were analyzed using SPSS version 26 while the qualitative approach used focus group discussions followed by content analysis.ResultsOut of the thirty people that participated in the workshop, twenty-five completed the questionnaires which were analyzed. The respondents included 15 (60.0%) medical doctors and 10 (40.0%) pharmacists. The mean age of the respondents was 36.39±7.23 years with mean year of practice of 9.48±6.01 years. Majority of them (84.0%) were in a position to provide input on the implementation of AMS in their facilities, although their managements had the final decision. The pharmacists (100%) were more likely to agree that antibiotic resistance was a problem for their practice than the medical doctors (78.6%) while equal number (80.0%) of respondents (pharmacists and medical doctors) believed that inappropriate prescribing was a problem. Having a specialized and dedicated team with effective monitoring was recognized as crucial for effective ASP while inadequate personnel was identified as a major barrier. We identified stakeholder's engagement, policies and regulation, as well as education as themes for improving AMS in the country.ConclusionThe results gave insight into the prescribers' perspective on the facilitators and barriers to antimicrobial stewardship; challenges and possible solutions to implementing ASPs in health facilities in Lagos State. We further identified pertinent contextual factors that need to be addressed when developing ASPs in healthcare facilities in a resource-poor setting.

Background Evidence-based policymaking is a paradigm aimed at increasing the use of evidence by actors involved in policymaking processes. The COVID-19 pandemic highlighted a heavy reliance on emerging evidence for policymaking during emergencies.Objective This study describes the focus and types of evidence in journal articles self-described as relevant to policymaking using the COVID-19 pandemic as a case study, identifying gaps in evidence and highlighting author stated perceived biases specifically in evidence-based policy making.Design Evidence mapping.Data sources We systematically searched SCOPUS, PubMed and LexisNexis for literature identifying policy-relevant evidence available on the COVID-19 pandemic.Eligibility criteria The study included only peer-reviewed literature identified as ‘article’, ‘book chapter’, ‘review’ covering the period from January 2020 to December 2022. Inclusion criteria required that articles have an abstract, authorship attribution and are written in English.Data extraction and synthesis A minimum of two authors independently extracted and coded for every level and final outputs were compared for consistency.Results A total of 213 articles met the inclusion criteria and were reviewed in this study. Lead authorship affiliations were from 50 countries with 70% of the outputs from developed economies including USA (20.2%), UK (18.3%) and Australia (7.5%). The most common purpose of the articles was the presentation of research findings the authors considered of relevance to policy (60.1%), followed by work that examined the impact of policy (28.6%) or highlighted or supported a policy need (22.5%), while some papers had multiple stated purposes. The most common challenges in policymaking identified by the authors of the reviewed papers were process failures and poor evidence utilisation during policymaking.Conclusions The evidence map identified the need for an interdisciplinary policy approach involving relevant stakeholders and driven by quality research as a progressive step towards prevention of future public health crises/pandemics.

When evidence-based policymaking is so often mired in disagreement and controversy, how can we know if the process is meeting its stated goals? We develop a novel mathematical model to study disagreements about adequate knowledge utilization, like those regarding wild horse culling, shark drumlines and facemask policies during pandemics. We find that, when stakeholders disagree, it is frequently impossible to tell whether any party is at fault. We demonstrate the need for a distinctive kind of transparency in evidence-based policymaking, which we call transparency of reasoning. Such transparency is critical to the success of the evidence-based policy movement, as without it, we will be unable to tell whether in any instance a policy was in fact based on evidence.

SETTING:This study is a retrospective review of a large-scale systematic TB screening project conducted in six states of Nigeria. OBJECTIVE:To determine the magnitude and characteristics of subclinical TB and the relative contributions of bacteriological versus clinical diagnosis in its identification in Nigeria. DESIGN:Data were retrospectively analysed from six states of Nigeria, where parallel screening with any TB symptoms and chest X-ray (CXR) with artificial intelligence (AI) was used for active case finding. Diagnosis of TB among presumptive was confirmed using either bacteriological tests or clinical review of CXR. RESULTS:Out of 8,516 presumptive identified during the project, 172 (2.0%) had no TB symptoms (males: 73.8%, females: 26.2%). The overall prevalence of TB among all presumptive was 21.9% (n = 1,867), including 62 (3.3%) subclinical TB and 1,805 (97.3%) active TB cases. The proportion of clinical diagnosis using CXR was significantly higher in the subclinical TB group than in the active TB group (79.0% vs. 63.5%; P = 0.012, OR = 2.2, 95% CI 1.17-4.03). CONCLUSION:Subclinical TB contributed 3.3% of the large TB burden in this study (22 per 100 presumptive). These cases would have been missed if only symptom-based TB screening had been employed.

Wastewater-based epidemiology (WBE) is already being adopted for the surveillance of health conditions of communities and shows great potential for the monitoring of infectious pathogens of public health importance. There is however paucity of robust data to support extensive WBE in Nigeria. This study evaluated the prevalence of clinically relevant infectious pathogens and provided antimicrobial resistance profiles of bacteria pathogens in wastewater canals in Lagos State at a single point in time. This is a cross-sectional survey of wastewater canals in 20 Local Government Areas (LGAs) in Lagos State for detection of bacteria pathogens of public health importance including non-tuberculous mycobacteria and SARS-Cov-2 virus using cultural analysis and conventional Polymerase Chain Reaction (PCR) techniques. Descriptive epidemiological survey of communities around the canals was done using questionnaires to assess exposure pathways. Statistical analysis was done using SPSS version 27 while P value of < 0.05 was considered as significant. Three thousand and fifty-four (3054) questionnaires were administered to 1215 (39.8

Background:Rampant chloroquine/hydroxychloroquine poisoning in Nigerian hospitals following suggestions of its possible efficacy in the treatment and prevention of the newly emerged COVID-19 disease informed this survey.Objectives:The aim of this study was to assess the knowledge, attitude and perception of the Nigerian populace on the use of chloroquine in the COVID-19 pandemic.Methods:This cross-sectional study was done by administering an electronic questionnaire created using Google Docs, through social media cascade methods including the WhatsApp application software to capture data on chloroquine use between April 20 and June 20, 2020.Results:Six hundred and twenty-eight people responded to the questionnaire (response rate 99.2%, mean age 41.05 ± 12.3) from the six geopolitical zones in Nigeria with 556 (88.5%) having tertiary level education. Only 21 (3.3%) of the respondents took chloroquine for treatment or prevention. Respondents from the North-west geopolitical zones used chloroquine 5.8 (95% CI: 1.55, 21.52, p=0.02) more times than other zones while the age group 20-29 were 8.8 times more likely to use chloroquine than any other age group (95% CI: 3.53, 21.70, p = 0.00). Female respondents were 2.3 times more likely to use chloroquine than the males (OR 2.26 95% CI: 0.90-5.68; p=0.08) and those in the income bracket of N75,000-99,000, 2.5 times more than other income groups.Conclusion:Young adults, North-western geopolitical zone, and female gender should be target groups for education on rational chloroquine use. The danger of chloroquine overdose should be communicated to the general population in Nigeria.

ABSTRACT Objective The study examined whether the benefit and adverse effects of the tenofovir-based highly active antiretroviral therapy (HAART) regimen outweigh the non-tenofovir-based regimen in the elderly population. Methods We searched PubMed, EMBASE, Cochrane Central Library, Google Scholar, and some hand searches on September 21, 2021, to identify eligible studies. Only randomized control trials on elderly HIV-positive patients on Tenofovir-based regimens living in sub-Saharan Africa were included. Studies on pregnant women or prophylactic tenofovir were excluded. The primary outcomes are viral suppression, mortality, and anemia. Two reviewers independently selected the studies, extracted data, and assessed the risk of bias. We analyzed using risk ratio, with 95% confidence intervals. A fixed effect model along with an assessment of heterogeneity was done for meta-analysis. Results Four studies with a total of 263 participants were included. Our meta-analysis shows that there was no difference between participants on a tenofovir-based regimen and the non-tenofovir-based regimen in terms of viral suppression, mortality, anemia, and hypertension. Our meta-analysis shows that there was no difference between participants on tenofovir based regimen and non-tenofovir based regimen in terms of viral suppression (RR=1.96, 95% CI (1.42 -2.70; I 2 =0%, 4 trials, 263 participants, very low certainty of evidence), mortality (RR = 2.90, 95% CI (0.12 – 69.87, I 2 =Not estimated, a trial, 120 participants, very low certainty of evidence), anaemia (RR=1.61, 95% CI (1.02-2.90; I 2 = 0.16, 2 trials, 154 participants, very low certainty of evidence), hypertension RR = 0.76, 95% CI (0.44-1.31) I 2 = Not estimated, a trial, 34 participants, low-certainty of evidence). None of the trials reported the incidence of chronic kidney disease and bone demineralization. Conclusion There was very-low certainty evidence that no difference exists between the tenofovir-based HAART regimen and the non-tenofovir-based regimen in terms of benefits and short-term adverse outcomes. Well-designed randomized clinical trials are needed with a focus on long-term adverse effects. ARTICLE SUMMARY Strengths and limitations of the study Tenofovir-based high-active antiretroviral therapy (HAART) is one of the preferred first-line therapies in the management of HIV-1 infection. The study demonstrates evidence and represents the first comprehensive and up-to-date systematic review and meta-analysis on the effects of the tenofovir-based regimen on elderly patients concerning chronic kidney disease, changes in bone mineral density, number of deaths, viral suppression, hypertension, anemia, and adherence levels of ≥ 95%. The clinical implications of the study indicate there is an urgent need for evaluation of the effect of long-term use of tenofovir-based regimens among elderly people living with HIV/AIDS due to the paucity of data on the use of tenofovir-based HAART regimens. The study limitations are the cumulative sample size of the four studies was small with only one study reporting on mortality outcome; there was also a lack of statistical power for the clinical outcomes observed; there was no information on gender disaggregation to consider conducting a sub-group analysis; and there was a great amount of heterogeneity in one of the studies, which was accounted for by using a random effects model but has the same value in a fixed effect model.

A wound is a rupture in the skin exposing the underlying subcutaneous tissue. It creates a moist, warm, and nutritive environment that is conducive to microbial colonization and proliferation. Depending on the time it takes for the wound to heal, it can be categorized as either acute or chronic. Infection in a wound elongates the healing period, causes longer hospital stays and higher treatment costs. The majority of open wound infections are polymicrobial containing both aerobic and anaerobic microorganisms, which should be taken into account when choosing antimicrobials. Due to the increasing prevalence of antibiotic resistance, the control of wound infections has become more challenging. In Nigeria, this challenge is exacerbated due to limited epidemiological data on the microbial agents causing wound infections. Thus, it is necessary to understand the microbes prevalent in infected wounds in order to encourage proper antimicrobial selection for the offending microbe and enhance better treatment and management outcomes. In this review, the bacteriology of wound infections, susceptibilities to routinely prescribed antibiotics and the effects of the presence of these bacterial species in wound management were discussed.

SETTING:This pilot project was conducted in hard-to-reach communities of two Niger Delta States in the South-South Region of Nigeria.OBJECTIVE:To assess the usefulness of portable digital X-ray, the Delft-Light Backpack (DLB) for TB active case-finding (ACF) in hard-to-reach Niger Delta communities using the WHO 3B TB screening/diagnosis algorithm.DESIGN:DLB X-ray was used to screen all consenting eligible participants during community TB screening out-reaches in all hard-to-reach communities of Akwa Ibom and Cross River States in the Niger Delta, Nigeria. Participants with a CAD4TB (computer-aided detection for TB score) ⩾60 had Xpert (sputum) and/or clinical (radiograph) assessment for TB diagnosis. Data from the project were analysed for this study.RESULTS:A total of 8,230 participants (males: 47.2%, females: 52.8%) underwent TB screening and 1,140 (13.9%) presumptive TB cases were identified. The TB prevalence among all participants and among those with presumptive TB were respectively 1.2% and 8.6%. The number needed to screen was 84. Among people with presumptive TB, the proportion of males and females with confirmed TB was respectively 12.0% and 5.6% (P < 0.001).CONCLUSION:TB screening using DLB X-ray during community-based ACF in hard-to-reach Niger Delta communities of Nigeria showed a high TB prevalence among participants. Nationwide deployment of the instrument in hard-to-reach areas is recommended.

Background: Access to testing for SARS-CoV-2 in Nigeria is still highly restricted.Only patients who are symptomatic for SARS-CoV-2 are selected for testing.This pattern of testing will miss a large proportion of individuals with the infection who are asymptomatic and presymptomatic.This study reports the experience of a symptom-based study from a large testing centre in Nigeria.Methods: A cross-sectional study, reviewing data collected from respondents presenting at the Nigerian Institute of Medical Research (NIMR) modified drive-through center for COVID-19 test between the period March 31st and August 31st, 2020 were included in the analysis.Results: A total of 9891 participants were recruited into the study and 2465 participants (24.9%) had a positive PCR result for SARS-CoV-2.The majority of the respondents were above 18 years old, n = 9163 (93.4%).The average age of the respondents was 36.7 years (sd 13.8 years).The age of the participants has a significant effect on SARS-CoV-2 status (AOR = 1.009,CI, 1.005 to 1.012, p = 0.0001).

Background Antimicrobial resistance (AMR) in bacterial pathogens is a worldwide concern that demands immediate attention. Most information on AMR originates from high-income countries and little is known about the burden in Africa, particularly Nigeria. Using four sentinel sites (General hospitals) in Lagos State, this study sought to estimate the burden of AMR. Methods This is a hospital-based surveillance using secondary health care centres. Four sites were randomly selected and included in the study. Clinical isolates were collected over a period of 6 months for each site from August 2020 to March 2021. All isolates were characterised and analysed for resistance to 15 antibiotics using the Kirby-Baur method. Multiplex PCR assay was used for the detection of Extended spectrum beta lactamase genes. Data analysis was done using SPSS version 27.0. Results Four hundred and ninety-nine (499) patients consented and participated in this study, consisting of 412 (82.6%) females and 87 (17.4%) males. The mean age ± SD of the participants was 33.9 ± 13.8 with a range of 1–89 years. The majority (90.8%) of the participants were outpatients. Two hundred and thirty-two (232) isolates were obtained from 219 samples, comprising of 120 (51.7%) Gram positive and 112 (48.3%) Gram negative organisms. Key bacterial pathogens isolated from this study included Staphylococcus aureus (22.8%), Escherichia coli (16.4%), Staphylococcus spp. (15.9%), Enterococcus spp. (7.3%) and Klebsiella pneumoniae (6.5%). There was high prevalence of multi-drug resistance (79.3%) among the isolates with 73.6% of Staphylococcus aureus phenotypically resistant to methicillin and 70% possessed the MecA gene. 76.5% of Enterococcus spp. isolated were Vancomycin resistant. Overall, resistance to Cephalosporins was most frequently/commonly observed (Cefotaxime 87.5%). Conclusion A high incidence of AMR was identified in clinical bacteria isolates from selected general hospitals in Lagos State, highlighting the necessity for the implementation of national action plans to limit the prevalence of AMR. Surveillance via collection of isolates has a lot of promise, especially in resource-limited environments.

COVID‐19 pandemic has posed unique challenges to the health providers involved with chronic diseases like Haemoglobin disorders (sickle cell disease). Therefore, this study highlights the susceptibility and severity of COVID‐19 associated with normal and haemoglobin variants. This study is a case series that includes patients evaluated between June and August 30, 2020, and diagnosed with COVID-19 by the Quantitative Polymerase Chain Reaction method. Alkaline haemoglobin electrophoresis was used to identify types of Haemoglobin genotype associated with mild-to-severe cases of COVID-19. A total of 697 COVID-19 patients were included in this study, with a mean age of 41.32 (12.917). There were more males (66.1%) than females. The most frequently detected genotype was AA (75.8%), followed by AS (22%). Severe conditions of COVID-19 were present in patients with HBAC 2(14.28%) and HBAS 13 (8.5%). Co-morbidities were present in (24.0%) of the patients, with a mortality rate of 1.3%. Patients with pneumonia in association with other co-morbidities are 26 times more likely to have severe SARS CoV-2 than those with only pneumonia, irrespective of their haemoglobin genotype profile. The clinical course is seen in normal haemoglobin, and the variant with COVID-19 was the same. It is suggested that people with haemoglobin variant are not at increased risk during COVID-19 infection or risk of a sickle cell crisis.

Objectives: Optimising antibiotic use in healthcare settings through antimicrobial stewardship programmes (ASPs) is critical to effectively treat infections, protect patients from harms caused by unnecessary antibiotic use, and combat antimicrobial resistance. This needs assessment was designed to provide the current status of ASPs in healthcare facilities in Lagos State and identify gaps for future interventions. Methods: A descriptive cross-sectional survey was conducted using a self-administered questionnaire to ascertain the extent and nature of ongoing ASPs among selected healthcare facilities and identify gaps for future interventional studies. Results: Of 32 questionnaires distributed, 25 (78%) were completed and returned from three tertiary, six secondary, eleven primary and five private healthcare facilities. The mean years of practice of respondents was 13.96 + 7.8 years (2-31 years). Six facilities (24%) had a team responsible for ASP operating at varying degrees of capacity, while five (20%) had a formal ASP. All six facilities with an antimicrobial stewardship (AMS) team had a medical doctor as the team lead, and 5 (20%) also had a pharmacist involved in implementation efforts. Routine pre-authorisation for specific antibiotic was performed in six facilities (24%), four of which monitor pre-authorisation interventions. Only two facilities (8%) performed prospective audit and feedback for specific antibiotic agents. Private healthcare facilities were more likely to have information technology (IT) capability to support the needs of AMS activities. Conclusion: This study revealed minimal ASP activities in healthcare facilities in Lagos State and highlighted possibilities of leveraging on available IT resources for a co-ordinated AMS strategy. (c) 2021 The Author(s). Published by Elsevier Ltd on behalf of International Society for Antimicrobial Chemotherapy. This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ )