Adebobola Bashorun

Comparison of audio computer assisted self-interview and face-to-face interview methods in eliciting HIV-related risks among men who have sex with men and men who inject drugs in Nigeria.

Introduction Face-to-face (FTF) interviews are the most frequently used means of obtaining information on sexual and drug injecting behaviours from men who have sex with men (MSM) and men who inject drugs (MWID). However, accurate information on these behaviours may be difficult to elicit because of sociocultural hostility towards these populations and the criminalization associated with these behaviours. Audio computer assisted self-interview (ACASI) is an interviewing technique that may mitigate social desirability bias in this context. Methods This study evaluated differences in the reporting of HIV-related risky behaviours by MSM and MWID using ACASI and FTF interviews. Between August and September 2010, 712 MSM and 328 MWID in Nigeria were randomized to either ACASI or FTF interview for completion of a behavioural survey that included questions on sensitive sexual and injecting risk behaviours. Data were analyzed separately for MSM and MWID. Logistic regression was run for each behaviour as a dependent variable to determine differences in reporting methods. Results MSM interviewed via ACASI reported significantly higher risky behaviours with both women (multiple female sexual partners 51% vs. 43%, p = 0.04; had unprotected anal sex with women 72% vs. 57%, p = 0.05) and men (multiple male sex partners 70% vs. 54%, p≤0.001) than through FTF. Additionally, they were more likely to self-identify as homosexual (AOR: 3.3, 95%CI:2.4–4.6) and report drug use in the past 12 months (AOR:40.0, 95%CI: 9.6–166.0). MWID interviewed with ACASI were more likely to report needle sharing (AOR:3.3, 95%CI:1.2–8.9) and re-use (AOR:2.2, 95%CI:1.2–3.9) in the past month and prior HIV testing (AOR:1.6, 95%CI 1.02–2.5). Conclusion The feasibility of using ACASI in studies and clinics targeting key populations in Nigeria must be explored to increase the likelihood of obtaining more accurate data on high risk behaviours to inform improved risk reduction strategies that reduce HIV transmission.

A description of HIV prevalence trends in Nigeria from 2001 to 2010: what is the progress, where is the problem?

Introduction Nigerias population of 160 million and estimated HIV prevalence of 3.34% (2011) makes Nigeria the second highest HIV burden worldwide, with 3.2 million people living with HIV (PLHIV). In 2010, US government spent about US

The Nigeria wealth distribution and health seeking behaviour: Evidence from the 2012 national HIV/AIDS and reproductive health survey

456.5 million on the Nigerian epidemic. Antenatal clinic (ANC) HIV sero-prevalence sentinel survey has been conducted biennially in Nigeria since 1991 to track the epidemic. This study looked at the trends of HIV in Nigeria over the last decade to identify progress and needs. Methods We conducted description of HIV sero-prevalence sentinel cross-sectional surveys conducted among pregnant women attending ANC from 2001 to 2010, which uses consecutive sampling and unlinked-anonymous HIV testing (UAT) in160 sentinel facilities. 36,000 blood samples were collected and tested. We used Epi-Info to determine national and state HIV prevalence and trends. The Estimation and Projection Package with Spectrum were used to estimate/project the burden of infection. Results National ANC HIV prevalence rose from 1.8% (1991) to 5.8% (2001) and dropped to 4.1% (2010). Since 2001, states in the center, and south of Nigeria had higher prevalence than the rest, with Benue and Cross Rivers notable. Benue was highest in 2001 (14%), 2005 (10%), and 2010 (12.7%). Overall, eight states (21.6%) showed increased HIV prevalence while six states (16.2%) had an absolute reduction of at least 2% from 2001 to 2010. In 2010, Nigeria was estimated to have 3.19 million PLHIV, with the general population prevalence projected to drop from 3.34% in 2011 to 3.27% in 2012. Conclusion Examining a decade of HIV ANC surveillance in Nigeria revealed important differences in the epidemic in states that need to be examined further to reveal key drivers that can be used to target future interventions.

Incidence and predictors of tuberculosis among HIV-infected adults after initiation of antiretroviral therapy in Nigeria, 2004-2012

BackgroundRecently, Nigeria emerged as the largest economy in Africa and the 26th in the world. However, a pertinent question is how this new economic status has impacted on the wealth and health of her citizens. There is a dearth of empirical study on the wealth distribution in Nigeria which could be important in explaining the general disparities in their health seeking behavior. An adequate knowledge of Nigeria wealth distribution will no doubt inform policy makers in their decision making to improve the quality of life of Nigerians.MethodThis study is a retrospective analysis of the assets of household in Nigeria collected during the 2012 National HIV/AIDS and Reproductive Health Survey (NARHS Plus 2). We used the principal component analysis methods to construct wealth quintiles across households in Nigeria. At 5% significance level, we used ANOVA to determine differences in some health outcomes across the WQs and chi-square test to assess association between WQs and some reproductive health seeking behaviours.ResultThe wealth quintiles were found to be internally valid and coherent. However, there is a wide gap in the reproductive health seeking behavior of household members across the wealth quintiles with members of households in lower quintiles having lesser likelihood (33.0%) to receive antenatal care than among those in the highest quintiles (91.9%). While only 3% were currently using modern contraceptives in the lowest wealth quintile, it was 17.4% among the highest wealth quintile (p < 0.05).ConclusionThe wealth quintiles showed a great disparity in the standard of living of Nigerian households across geo-political zones, states and rural–urban locations which had greatly influenced household health seeking behavior.

A Decade of Monitoring HIV Epidemics in Nigeria: Positioning for Post-2015 Agenda

Background Nigeria had the most AIDS-related deaths worldwide in 2014 (170,000), and 46% were associated with tuberculosis (TB). Although treatment of people living with HIV (PLHIV) with antiretroviral therapy (ART) reduces TB-associated morbidity and mortality, incident TB can occur while on ART. We estimated incidence and characterized factors associated with TB after ART initiation in Nigeria. Methods We analyzed retrospective cohort data from a nationally representative sample of adult patients on ART. Data were abstracted from 3,496 patient records, and analyses were weighted and controlled for a complex survey design. We performed domain analyses on patients without documented TB disease and used a Cox proportional hazard model to assess factors associated with TB incidence after ART. Results At ART initiation, 3,350 patients (95.8%) were not receiving TB treatment. TB incidence after ART initiation was 0.57 per 100 person-years, and significantly higher for patients with CD4<50/μL (adjusted hazard ratio [AHR]: 4.2, 95% confidence interval [CI]: 1.4–12.7) compared with CD4≥200/μL. Patients with suspected but untreated TB at ART initiation and those with a history of prior TB were more likely to develop incident TB (AHR: 12.2, 95% CI: 4.5–33.5 and AHR: 17.6, 95% CI: 3.5–87.9, respectively). Conclusion Incidence of TB among PLHIV after ART initiation was low, and predicted by advanced HIV, prior TB, and suspected but untreated TB. Study results suggest a need for improved TB screening and diagnosis, particularly among high-risk PLHIV initiating ART, and reinforce the benefit of early ART and other TB prevention efforts.

Investigating institutional maternal deaths in Ogun State, Nigeria: analysis of 2016 maternal and perinatal deaths surveillance data

BackgroundNigeria accounts for 9% of the global HIV burden and is a signatory to Millennium Development Goals as well as the post-2015 Sustainable Development Goals. This paper reviews maturation of her HIV M&E system and preparedness for monitoring of the post-2015 agenda.MethodsUsing the UNAIDS criteria for assessing a functional M&E system, a mixed-methods approach of desk review and expert consultations, was employed.ResultsFollowing adoption of a multi-sectoral M&E system, Nigeria experienced improved HIV coordination at the National and State levels, capacity building for epidemic appraisals, spectrum estimation and routine data quality assessments. National data and systems audit processes were instituted which informed harmonization of tools and indicators. The M&E achievements of the HIV response enhanced performance of the National Health Management Information System (NHMIS) using DHIS2 platform following its re-introduction by the Federal Ministry of Health, and also enabled decentralization of data management to the periphery.ConclusionA decade of implementing National HIV M&E framework in Nigeria and the recent adoption of the DHIS2 provides a strong base for monitoring the Post 2015 agenda. There is however a need to strengthen inter-sectoral data linkages and reduce the rising burden of data collection at the global level.

Evaluation of malaria surveillance system in Ogun State, Nigeria: 2011 - 2015

Introduction : globally over 600,000 women die annually from complications of pregnancy. Nigeria ranks second globally in the number of maternal deaths. Ogun State has maternal mortality rate (MMR) of 179 per 100000 live births, with 5728 women dying of pregnancy related complications annually. Ogun State has a total fertility rate of 5.4 and contraceptive prevalence rate of 26%. Maternal and Perinatal Deaths Surveillance and Response (MPDSR) started as Maternal Death Review (MDR) in Ogun State in year 2009. The initiative was geared towards conducting qualitative assessment of the causes of maternal and perinatal deaths for evidence-based decisions to prevent reoccurrences of such preventable deaths. This study describes the outcome of maternal death review conducted in selected health facilities in Ogun State to give insight to why women die from pregnancy and related events. Methods : this is a cross-sectional study. We conducted desk review of 2016 Ogun State Maternal death review (MDR) forms retrieved from the Monitoring and Evaluation unit of Ogun State Primary Health Care Development Board. A total sampling of the health facilities conducting MPDSR in the State was taken and the study population constitutes all cases of maternal deaths in those facilities. Data analysis was done using SPSS software version 20.0. We determined the Frequencies, proportions, means, ratio and proportionate risk of the variables abstracted. Results : the health facilities offering MPDSR notified 49 maternal deaths in 2016 and reviewed 32 (63%) of the maternal deaths. Average age at death was 30.8+5.7 years, 41(92%) of them were married, 31(69%) lived in urban areas, 27(55%) belonged to the low socio-economic class. The average institutional mortality ratio (iMMR) obtained was 534 per 100,000 live births. Thirty nine (88%) of the women delivered via a caesarean section. Thirty of the women (61%) died at peurperium. Haemorrhage accounts for 22 (43%) of maternal deaths while eclampsia accounts for 8 (36%) of deaths. Conclusion : haemorrhage and ecclampsia are the leading cause of maternal deaths with most maternal deaths occurring postpartum. It is important to involve other Health facilities and communities in the surveillance to obtain a representative outcome of death review to facilitate intervention.

HIV sero-positivity among antenatal clinic attendees and their discordant partners in Lagos State, 2013 - 2016

Introduction : an estimated 3.2 billion people worldwide are at risk of having Malaria and sub-Saharan Africa carries the highest burden. Nigeria has 97% of her population at risk of Malaria and accounts for 32% of global Malaria deaths. Ogun State is endemic for Malaria with a prevalence of 62.7%. Effective Malaria Surveillance System is crucial to the control and elimination of Malaria. We evaluated the Malaria Surveillance System in Ogun State to describe its attributes. Methods : we evaluated the system using the “Centers for Disease Control’s updated Guidelines for Evaluating Public Health Surveillance Systems, 2001”. We did a retrospective review of Malaria specific data in Integrated Disease Surveillance and Response (IDSR) case summary forms from 2011 to 2015. We conducted descriptive analysis of cases using Microsoft Excel. Six key stakeholders were interviewed and a semi-structured questionnaire was administered to the 40 surveillance officers (SOs) in the State. Results : thirty-seven (93%) of the SOs reported that changes in the data capture tools and case management have been accommodated. Case definitions were understood by 40 (100%) of the SOs. Thirty-five (88%) of the SOs reported that the system was simple. All the Stakeholders interviewed and 38 (95%) of the SOs reported that the system was acceptable. Data was essentially from public health facilities excluding those from tertiary and private health facilities and thus not representative. Thirty-five (88%) SOs reported that data quality was enhanced by quarterly supportive supervision. There was late reporting among 100 (20%) of the 477 health facilities. Only 60% of the health facilities reports were timely which is below the State’s 80% target. Conclusion : malaria surveillance system in Ogun State is simple, flexible, and acceptable. The data from the system is not representative .We recommended involvement of the tertiary and private health facilities in the State to enhance representativeness and improve data quality.

Prevalence of Buruli ulcer in Osun State, Nigeria, 2016 - 2017

Introduction : Nigeria has the second largest number of people living with HIV (PLWH) (3.1 million) after South Africa (5.6 million) and accounts for 10% of the global HIV burden. Lagos State is one of the priority States in Nigeria with a high population (over 20 million). Sero-discordance applies when one partner of an intimate couple pair’s HIV result is positive and other negative. A discordant status is particularly risky because regular coitus without condoms is more probable in stable long-term partnerships (married or cohabiting). The aim is to study the trends of HIV sero-positivity among antenatal clinic attendees and their discordant partners. Methods : secondary data from the National Health Management Information System (NHMIS) was extracted through the District Health Information System (DHIS) platform, cleaned and analysed with Microsoft excel for frequency and proportion. Results : in 2013 the HIV prevalence amongst ANC attendee in the health facilities of Lagos state was 2.83% with slight increase to 4.77% in 2014 and a decline to 2.77% and 1.88% in 2015 and 2016 respectively. In 2013 only 2.35% of women knew their HIV status at antenatal (ANC), the proportion increased slightly to 4.35% in 2014 with a decline to 2.54% and 1.69% in 2015 and 2016 respectively. There were 2300 (37.6%), 2347 (27.0%), 2314 (32.6%) and 1527(35.6%) sero-discordant partners in 2013, 2014, 2015 and 2016 respectively. Of the sero discordant partners 1780, 1770, 1573 and 1276 were partners of HIV Positive women who tested Negative in 2013, 2014, 2015 and 2016 respectively. Also, of the sero discordant partners 520 (22.6%), 577 (24.6%), 741(32%) and 251(16.4%) were partners of HIV Negative pregnant women who tested HIV Positive for 2013, 2014, 2015 and 2016 respectively. Conclusion : the data revealed a decline in HIV prevalence among pregnant women in Lagos State; however HIV sero-discordant partners may be responsible for new Paediatric infection within heterosexual transmission setting. We therefore recommend that couple counseling should be enforced during ANC.

Mortality Among Confirmed Lassa Fever Cases During the 2015–2016 Outbreak in Nigeria

Introduction : buruli ulcer (BU) is a chronic debilitating, neglected but treatable tropical diseases caused by Mycobacterium ulcerans. Globally, it is the third most common mycobacterial infection in humans after tuberculosis and leprosy. There is paucity of data on the burden of BU in Nigeria. This study aimed to assess the magnitude and distribution of BU in Osun State, Nigeria.