Setting: Nigeria, a high tuberculosis (TB) burden country. Objective: To study the rate, distribution and causes of unsuccessful Xpert ^® MTB/RIF test outcomes, with the aim of identifying key areas that need to be strengthened for optimal performance of the assay. Design: This was a retrospective analysis of data uploaded between January and December 2015 from Xpert facilities to the central server using GXAlert. Result: Of 52 219 test results uploaded from 176 Xpert machines, 22.5% were positive for Mycobacterium tuberculosis, 10.8% of which were rifampicin-resistant; 4.7% of the total number of results were invalid, 4.2% had error results and 2.1% no result outcomes. Technical errors were most frequent (69%); these were non-seasonal and occurred in all geopolitical regions and at all health facility levels. Temperature-related errors were more prevalent in the North-West Region, with peaks in April to June. Peak periods for temperature and machine malfunction errors coincided with the periods of low utilisation of the assay. Conclusion: The key challenge affecting performance was poor adherence to standard operating procedures. Periodic refresher training courses, regular supervision, preventive maintenance of Xpert machines and proper storage of cartridges are strategies that could improve Xpert performance.

Background: Undiagnosed tuberculosis (TB) cases are the major challenge to TB control in Nigeria. An early warning outbreak recognition system (EWORS) is a system that is primarily used to detect infectious disease outbreaks; this system can be used as a case-based geospatial tool for the real-time identification of hot spot areas with clusters of TB patients. TB screening targeted at such hot spots should yield more TB cases than screening targeted at non–hot spots. Objective: We aimed to demonstrate the effectiveness of an EWORS for TB hot spot mapping as a tool for detecting areas with increased TB case yields in high TB-burden states of Nigeria. Methods: KNCV Tuberculosis Foundation Nigeria deployed an EWORS to 14 high-burden states in Nigeria. The system used an advanced surveillance mechanism to identify TB patients’ residences in clusters, enabling it to predict areas with elevated disease spread (ie, hot spots) at the ward level. TB screening outreach using the World Health Organization 4-symptom screening method was conducted in 121 hot spot wards and 213 non–hot spot wards selected from the same communities. Presumptive cases identified were evaluated for TB using the GeneXpert instrument or chest X-ray. Confirmed TB cases from both areas were linked to treatment. Data from the hot spot and non–hot spot wards were analyzed retrospectively for this study. Results: During the 16-month intervention, a total of 1,962,042 persons (n=734,384, 37.4% male, n=1,227,658, 62.6% female) and 2,025,286 persons (n=701,103, 34.6% male, n=1,324,183, 65.4% female) participated in the community TB screening outreaches in the hot spot and non–hot spot areas, respectively. Presumptive cases among all patients screened were 268,264 (N=3,987,328, 6.7%) and confirmed TB cases were 22,618 (N=222,270, 10.1%). The number needed to screen to diagnose a TB case in the hot spot and non–hot spot areas was 146 and 193 per 10,000 people, respectively. Conclusions: Active TB case finding in EWORS-mapped hot spot areas yielded higher TB cases than the non–hot spot areas in the 14 high-burden states of Nigeria. With the application of EWORS, the precision of diagnosing TB among presumptive cases increased from 0.077 to 0.103, and the number of presumptive cases needed to diagnose a TB case decreased from 14.047 to 10.255 per 10,000 people.

Background: In Nigeria, most children with tuberculosis (TB) present at primary health clinics where there are limited personnel skilled in collecting appropriate respiratory specimens from those who cannot produce sputum. KNCV Nigeria, in collaboration with the National Tuberculosis Control Program, implemented a modified simple, one-step (SOS), stool-based Xpert MTB/RIF method for diagnosis of TB in children who cannot expectorate sputum. We evaluated the impact of its implementation on childhood TB diagnosis. Method: A cross-sectional study was conducted across 14 selected states using secondary data of children presumed to have TB. Stool was collected from children presumed to have TB and processed using Xpert. Result: Out of 52,117 presumptive TB cases, 52% were male and 59.7% were under 5 years old. A total of 2440 (5%) cases were diagnosed with TB, and 2307 (95%) were placed on treatment. Annual TB notifications increased significantly after the introduction of the stool-based Xpert test when compared to those in the pre-implementation period. Increasing contributions from stool testing were observed throughout the implementation period, except in 2020 during the COVID-19 era. Overall, stool Xpert testing improved childhood TB notification in the studied states. Interventions aimed at awareness creation, capacity building, and active case finding improved the performance of the test.

Healthcare workers (HCWs) are regarded as role models regarding health-related issues, including vaccination. Therefore, it is essential to identify the predictors for COVID-19 vaccine acceptance among them. A cross-sectional study to assess the risk perception, attitudes and knowledge of HCWs toward COVID-19 vaccination was carried out. A total of 710 responses were received between September 2021 and March 2022, from HCWs in the Northern, Western and Eastern regions of Nigeria. Cross tabulations were performed to determine statistical relations between sociodemographic variables, knowledge, attitudes and risk perceptions concerning COVID-19 vaccine acceptance. Multinomial logistic regression analysis was performed to determine the predictive variables for COVID-19 vaccine acceptance. Statistical analyses were performed and P-values less than 0.05 were considered statistically significant at a CI of 95%. Results showed that 59.3% of the participants were amenable to COVID-19 vaccines. Multinomial regression analysis identified 14 variables at α < 0.05 as predictors for vaccine acceptance. Male HCWs were 2.8 times more likely to accept the vaccine than their female counterparts. HCWs that were knowledgeable of the different kinds of vaccines, were willing to recommend the vaccines to their patients, believed that the timing of COVID-19 vaccination was appropriate and had recent vaccination history within three years were 1.6, 24.9, 4.4 and 3.1 times more likely to take COVID-19 vaccine than those not sure. The study found a relatively high trust (51.3%) in the Nigerian Center for Disease Control (NCDC) for information regarding COVID-19 vaccines. Therefore, the NDCD should disseminate more robust insights regarding the safety profiles of various COVID-19 vaccines.

Widespread COVID-19 vaccination is essential to maintaining pandemic control. However, low- and lower-middle-income countries (LMICs) continue to face challenges to care due to unequal access and vaccine fear despite the introduction of safe and effective immunizations. This study aimed to collect information on Nigeria’s COVID-19 vaccine uptake rates and determinants. Science Direct, PubMed, Google Scholar, African Journal Online, Springer, and Hinari were all systematically searched through and completed in May 2022. Quality assessments of the listed studies were performed using the eight-item Joanna Briggs Institute Critical Appraisal tools for cross-sectional studies. In addition, we undertook a meta-analysis to calculate pooled acceptance rates with 95% confidence intervals (CI). Forty-two studies in total satisfied the inclusion criteria and were reviewed. A total of 24,533 respondents were studied. The total sample size of states in the Northern, Western and Southern parts of Nigeria are 3,206, 4,527 and 5,059, respectively, while 11,741 is the cumulative sample size of all the Nigeria-wide studies. The total COVID-19 vaccination acceptance rate among all the study groups was 52.4% (95% CI: 46.9-57.9%, I ² = 100%), while the total estimated COVID-19 vaccination hesitancy rates was 47.81% (95% CI: 42.2 – 53.4% I ² = 100%). In Nigeria-regions sub-group analyses, the Western region (58.90%, 95% CI: 47.12–70.27%) and Northern region (54.9%, 95% CI: 40.11%–69.4%) showed the highest rates of vaccine acceptance and vaccine hesitancy respectively. The COVID-19 vaccine acceptance rate was highest in 2020, with a pooled rate of 59.56% (46.34, 57.32%, I ² = 98.7%). The acceptance rate in 2021 was only 48.48 (40.78%, 56.22%), while for the studies in 2022, it increased to 52.04% (95% CI: 35.7%, 68.15 %). The sensitization of local authorities and the dissemination of more detailed information about the COVID-19 vaccine and its safety, could significantly increase the country’s vaccination rate.

The propensity to develop resistance to antibiotics has accounted for the predominance of Bacteroides and Prevotella in infections due to anaerobic bacteria. The observed differences in resistance pattern across geographical boundaries underscored the timeliness for this study to review data on antibiotic susceptibility and resistance markers amongst Bacteroides and Prevotella to β-lactams, lincosamide and nitroimidazole from selected hospitals in Lagos, Nigeria from 1992-2011. Bacteroides, mostly B. fragilis were the sole anaerobic gram negative bacilli in peritonitis following lower abdominal surgery and bloodstream infections, while Prevotella bivia and P. melaninogenica were more frequent in periodontal abscess, pelvic inflammatory disease and chronic suppurative otitis media. The MIC range and MIC90 of the anaerobes for the antibiotics does not indicate changes in group resistance to antibiotics though isolated cases were recorded. While clear cut patterns were not established for other species, B. fragilis resistance increased for amoxicillin-clavulanic acid from 18.2% in 1992-1996 to 31.4% in 2006-2011 and from 27.3% in 1992-1996 to 34.3% in 2006-2011 for cefoxitin. In contrast, decrease susceptibility was obtained against clindamycin (54.5% in 1992-1996 to 22.9% in 2006-2011). Similarly, 22.7% of B. fragilis strains have the cepA and/or cfxA gene in 1992-1996 compared to 32.1% in 2006-2011. While not all isolates with cepA and/or cfxA genes were resistant to the β-lactams, all isolates carrying the ermF or nim genes were resistant to the lincosamide (clindamycin) or nitroimidazole (metronidazole) respectively. The presence of antibiotics resistance genes can be used in tracking resistance amongst species of Bacteroides and Prevotella. With emerging new technologies, gene screening may prove more effective and reliable for therapeutic decisions for anaerobic bacterial infections especially since the genes can be screened from the infective exudates. This will eliminate the need for culture and antibiotic susceptibility testing for this group of fastidious microorganisms.