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Luedtke S, Wood C, Olufemi O, Okonji P, Kpokiri EE, Musah A, Bammeke F, Mutiu B, Ojewola R, Bankole O, Ademuyiwa A, Ekumankama C, Theophilus A, Aworabhi-Oki N, Shallcross L, Molnar A, Wiseman S, Hayward A, Birjovanu G, Lefevre C, Petrou S, Ogunsola F, Kostkova P. Gamified antimicrobial decision support app (GADSA) changes antibiotics prescription behaviour in surgeons in Nigeria: a hospital-based pilot study. Antimicrob Resist Infect Control 2023; 12:141. [PMID: 38053212 PMCID: PMC10699010 DOI: 10.1186/s13756-023-01342-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/20/2023] [Indexed: 12/07/2023] Open
Abstract
AIMS Surgical Antibiotic Prophylaxis (SAP) in Nigeria is often not evidence based. The aim of this study is to test if the GADSA application can change prescription behaviour of surgeons in Nigeria. In addition, the study aims to identify AMS strategies and policies for the future. METHODS The GADSA gamified decision support app uses WHO and Sanford prescribing guidelines to deliver real-time persuasive technology feedback to surgeons through an interactive mentor. The app can advise on whether clinician's decisions align with SAP recommendations and provides the opportunity for clinicians to make adjustments. Twenty surgeons actively participated in a 6-month pilot study in three hospitals in Nigeria. The surgeons determined the risk of infection of a surgical procedure, and the need, type and duration of SAP. The study used a longitudinal approach to test whether the GADSA app significantly changed prescribing behaviour of participating surgeons by analysing the reported prescription decisions within the app. RESULTS 321 SAP prescriptions were recorded. Concerning the surgical risk decision, 12% of surgeons changed their decision to be in line with guidelines after app feedback (p < 0.001) and 10% of surgeons changed their decision about the need for SAP (p = 0.0035) to align with guidelines. The change in decision making for SAP use in terms of "type" and "duration" to align with guidelines was similar with 6% and 5% respectively (both p-values < 0.001). CONCLUSION This study suggests that the GADSA app, with its game based and feedback feature, could significantly change prescribing behaviour at the point of care in an African setting, which could help tackle the global challenge of antibiotic resistance.
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Affiliation(s)
- Susanne Luedtke
- UCL IRDR Centre for Digital Public Health in Emergencies, University College London, Gower Street, London, WC1E 6BT, UK.
| | - Caroline Wood
- UCL IRDR Centre for Digital Public Health in Emergencies, University College London, Gower Street, London, WC1E 6BT, UK
| | - Olajumoke Olufemi
- Department of Medical Microbiology, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Patrick Okonji
- Department of Medical Microbiology, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Eneyi E Kpokiri
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Department of Pharmacy, Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State, Nigeria
| | - Anwar Musah
- UCL IRDR Centre for Digital Public Health in Emergencies, University College London, Gower Street, London, WC1E 6BT, UK
| | - Funmi Bammeke
- Department of Sociology, University of Lagos, Lagos, Nigeria
| | - Bamidele Mutiu
- Department of Medical Microbiology, Lagos State University College of Medicine/Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Rufus Ojewola
- Urology Unit, Department of Surgery, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Olufemi Bankole
- Neurosurgery Unit, Department of Surgery, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Adesoji Ademuyiwa
- Paediatric Surgery Unit, Department of Surgery, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Chibuzo Ekumankama
- Department of Ophthalmology, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Ayibanoah Theophilus
- Department of Pharmacy, Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State, Nigeria
| | - Neni Aworabhi-Oki
- Department of Surgery, Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State, Nigeria
| | - Laura Shallcross
- Institute of Infectious Diseases Informatics, University College London, London, UK
| | - Andreea Molnar
- School of Software and Electrical Engineering, Swinburne University of Technology, Melbourne, Australia
| | - Sue Wiseman
- UCL IRDR Centre for Digital Public Health in Emergencies, University College London, Gower Street, London, WC1E 6BT, UK
| | - Andrew Hayward
- Institute of Epidemiology and Public Health, University College London, London, UK
| | - Georgiana Birjovanu
- UCL IRDR Centre for Digital Public Health in Emergencies, University College London, Gower Street, London, WC1E 6BT, UK
| | - Carmen Lefevre
- UCL Centre for Behaviour Change, University College London, London, UK
| | - Stylianos Petrou
- UCL IRDR Centre for Digital Public Health in Emergencies, University College London, Gower Street, London, WC1E 6BT, UK
| | - Folasade Ogunsola
- Department of Medical Microbiology, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Patty Kostkova
- UCL IRDR Centre for Digital Public Health in Emergencies, University College London, Gower Street, London, WC1E 6BT, UK
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Oladele RO, Ettu AO, Medugu N, Habib A, Egbagbe E, Osinaike T, Makanjuola OB, Ogunbosi B, Irowa OO, Ejembi J, Uwaezuoke NS, Adeleke G, Mutiu B, Ogunsola F, Rotimi V. Antibiotic Guidelines for Critically Ill Patients in Nigeria. West Afr J Med 2023; 40:962-972. [PMID: 37768104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
BACKGROUND It is well documented that inappropriate use of antimicrobials is the major driver of antimicrobial resistance. To combat this, antibiotic stewardship has been demonstrated to reduce antibiotic usage, decrease the prevalence of resistance, lead to significant economic gains and better patients' outcomes. In Nigeria, antimicrobial guidelines for critically ill patients in intensive care units (ICUs), with infections are scarce. We set out to develop antimicrobial guidelines for this category of patients. METHODS A committee of 12 experts, consisting of Clinical Microbiologists, Intensivists, Infectious Disease Physicians, Surgeons, and Anesthesiologists, collaborated to develop guidelines for managing infections in critically ill patients in Nigerian ICUs. The guidelines were based on evidence from published data and local prospective antibiograms from three ICUs in Lagos, Nigeria. The committee considered the availability of appropriate antimicrobial drugs in hospital formularies. Proposed recommendations were approved by consensus agreement among committee members. RESULTS Candida albicans and Pseudomonas aeruginosa were the most common microorganisms isolated from the 3 ICUs, followed by Klebsiella pneumoniae, Acinetobacter baumannii, and Escherichia coli. Targeted therapy is recognized as the best approach in patient management. Based on various antibiograms and publications from different hospitals across the country, amikacin is recommended as the most effective empiric antibiotic against Enterobacterales and A. baumannii, while colistin and polymixin B showed high efficacy against all bacteria. Amoxicillin-clavulanate or ceftriaxone was recommended as the first-choice drug for community-acquired (CA) CA-pneumonia while piperacillin-tazobactam + amikacin was recommended as first choice for the treatment of healthcare-associated (HA) HA-pneumonia. For ventilatorassociated pneumonia (VAP), the consensus for the drug of first choice was agreed as meropenem. Amoxycillin-clavulanate +clindamycin was the consensus choice for CAskin and soft tissue infection (SSIS) and piperacillin-tazobactam + metronidazole ±vancomycin for HA-SSIS. Ceftriaxone-tazobactam or piperacillin-tazobactam + gentamicin was consensus for CA-blood stream infections (BSI) with first choice+regimen for HA-BSI being meropenem/piperacillin-tazobactam +amikacin +fluconazole. For community-acquired urinary tract infection (UTI), first choice antibiotic was ciprofloxacin or ceftriaxone with a catheter-associated UTI (CAUTI) regimen of first choice being meropenem + fluconazole. CONCLUSION Data from a multicenter three ICU surveillance and antibiograms and publications from different hospitals in the country was used to produce this evidence-based Nigerian-specific antimicrobial treatment guidelines of critically ill patients in ICUs by a group of experts from different specialties in Nigeria. The implementation of this guideline will facilitate learning, continuous improvement of stewardship activities and provide a baseline for updating of guidelines to reflect evolving antibiotic needs.
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Affiliation(s)
- R O Oladele
- College of Medicine, University of Lagos, Lagos State, Nigeria
- Lagos University Teaching Hospital, Idi-Araba, Lagos State
| | - A O Ettu
- Lagos State Health Service Commission, Lagos 102273, Nigeria
| | - N Medugu
- Nile University of Nigeria, Abuja, Nigeria. +234-8059083612
| | - A Habib
- Bayero University Kano, Kano State, Nigeria
- Aminu Kano Teaching Hospital, Kano State, Nigeria
| | - E Egbagbe
- University of Benin, Benin City, Edo State, Nigeria
- University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
| | - T Osinaike
- University of Ibadan, Ibadan, Oyo Sate, Nigeria
- University College Hospital, Ibadan, Oyo Sate, Nigeria
| | - O B Makanjuola
- University of Ibadan, Ibadan, Oyo Sate, Nigeria
- University College Hospital, Ibadan, Oyo Sate, Nigeria
| | - B Ogunbosi
- University of Ibadan, Ibadan, Oyo Sate, Nigeria
- University College Hospital, Ibadan, Oyo Sate, Nigeria
| | - O O Irowa
- University of Benin, Benin City, Edo State, Nigeria
- University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
| | - J Ejembi
- Ahmadu Bello University, Zaria, Kaduna State, Nigeria
- Ahmadu Bello University Teaching Hospital, Kaduna State, Nigeria
| | | | - G Adeleke
- College of Medicine, University of Lagos, Lagos State, Nigeria
- Lagos University Teaching Hospital, Idi-Araba, Lagos State
| | - B Mutiu
- Lagos State University College of Medicine, Ikeja, Lagos State, Nigeria
| | - F Ogunsola
- College of Medicine, University of Lagos, Lagos State, Nigeria
- Lagos University Teaching Hospital, Idi-Araba, Lagos State
| | - V Rotimi
- Center for Infection Control and Patient Safety
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Ogun SA, Erinoso O, Aina OO, Ojo OI, Adejumo O, Adeniran A, Bowale A, Olaniyi CA, Adedoyin BM, Mutiu B, Saka B, Oshinaike O, Arabambi W, Adejumo F, Shuaib O, Salmon AO, Abdur-Razzaq H, Njokanma OF, Ojini O, Ogboye O, Lajide O, Wright KO, Osibogun A, Abayomi A. Efficacy of Hexetidine, Thymol and Hydrogen Peroxide-Containing Oral Antiseptics in Reducing Sars-Cov-2 Virus in the Oral Cavity: A Pilot Study. West Afr J Med 2022; 39:83-89. [PMID: 35167198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Studies have demonstrated the role of sputum as a site of severe acute respiratory syndrome-coronavirus-2 (SARSCoV-2) transmission. However, there is limited literature on the virucidal efficacy of oral antiseptics against SARS-CoV-2 virus. This study investigated the virucidal efficacy of three oral-antiseptics compared to a placebo-control in the sputum of SARS-CoV-2 infected individuals. METHODOLOGY A pilot study of adults with SARS-CoV-2 positive results, as determined by reverse transcription-polymerase chain reaction (RT-PCR) of <7 days. The oral antiseptics investigated were: Hexetidine (0.1% w/v); Thymol (0.063% w/v) and H2O2(1.5%) compared to de-mineralized sterile water (Placebo-control). The primary outcome measure was the proportion of negative RT-PCR results at 15-mins, 30-mins, 1-hour, 2-hours and 4-hours After Oral antiseptics Interventions (AOI) compared to the placebo-control. Statistical analysis was done using STATA 15.0 software with p-values of <0.05 considered statistically significant. RESULTS Data from a total of 66 participants that were RT-PCR SARS-CoV-2 positive at baseline (0-min) was analysed. At 15-mins AOI, the highest proportion of negativation from sputum samples was observed in the Hexedine group, with 69.2% of the baseline PCR positive cases converting to negative compared to 46.7% in the placebo-control group. In addition, H2O2 demonstrated efficacy at 2-hours AOI compared to placebo-control (62.5% vs 37.5% respectively) and other oral-antiseptics. Across all time-points, the oral-antiseptic groups compared to the placebo-control group, there was no statistically significant difference in the proportion of sputum samples which converted to a negative status (p>0.05). CONCLUSION The findings in this study suggest there was no significant difference in the proportion of participants who converted to a negative sputum status across the treatment groups at various time points. Future studies could compare the cycle threshold (ct) viral titre values of sputum samples to determine quantitative differences.
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Affiliation(s)
- S A Ogun
- Neurology Unit, Department of Medicine, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - O Erinoso
- Lagos State University Teaching Hospital, Lagos, Nigeria
| | - O O Aina
- Nigerian Institute of Medical Research, Lagos, Nigeria
| | - O I Ojo
- Lagos State University Teaching Hospital, Lagos, Nigeria
| | - O Adejumo
- Mainland Hospital, Yaba, Lagos, Nigeria
| | - A Adeniran
- Lagos State University Teaching Hospital, Lagos, Nigeria
| | - A Bowale
- Mainland Hospital, Yaba, Lagos, Nigeria
| | - C A Olaniyi
- Lagos State University Teaching Hospital, Lagos, Nigeria
| | - B M Adedoyin
- National Orthopaedic Hospital, Igbobi, Lagos State, Nigeria
| | - B Mutiu
- Lagos State Biobank, Nigeria
| | - B Saka
- Lagos State Biobank, Nigeria
| | - O Oshinaike
- Lagos State University Teaching Hospital, Lagos, Nigeria
| | - W Arabambi
- Neurology Unit, Department of Medicine, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - F Adejumo
- Mainland Hospital, Yaba, Lagos, Nigeria
| | - O Shuaib
- Lagos State University Teaching Hospital, Lagos, Nigeria
| | - A O Salmon
- Lagos State University Teaching Hospital, Lagos, Nigeria
| | | | - O F Njokanma
- Lagos State University Teaching Hospital, Lagos, Nigeria
| | - O Ojini
- College of Medicine, University of Lagos, Lagos, Nigeria
| | - O Ogboye
- Lagos State Ministry of Health, Lagos, Nigeria
| | - O Lajide
- Lagos State Ministry of Health, Lagos, Nigeria
| | - K O Wright
- Lagos State University Teaching Hospital, Lagos, Nigeria
| | - A Osibogun
- College of Medicine, University of Lagos, Lagos, Nigeria
| | - A Abayomi
- Lagos State Ministry of Health, Lagos, Nigeria
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4
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Wood CE, Luedtke S, Musah A, Bammeke F, Mutiu B, Ojewola R, Bankole O, Ademuyiwa AO, Ekumankama CB, Ogunsola F, Okonji P, Kpokiri EE, Ayibanoah T, Aworabhi-Oki N, Shallcross L, Molnar A, Wiseman S, Hayward A, Soriano D, Birjovanu G, Lefevre C, Olufemi O, Kostkova P. OUP accepted manuscript. JAC Antimicrob Resist 2022; 4:dlac044. [PMID: 35445194 PMCID: PMC9015911 DOI: 10.1093/jacamr/dlac044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 03/29/2022] [Indexed: 11/30/2022] Open
Abstract
Background In Nigeria, the prescription of surgical antibiotic prophylaxis for prevention of surgical site infection tends to be driven by local policy rather than by published guidelines (e.g. WHO and Sanford). Objectives To triangulate three datasets and understand key barriers to implementation using a behavioural science framework. Methods Surgeons (N = 94) from three teaching hospitals in Nigeria participated in an online survey and in focus group discussions about barriers to implementation. The theoretical domains framework (TDF) was used to structure question items and interview schedules. A subgroup (N = 20) piloted a gamified decision support app over the course of 6 months and reported barriers at the point of care. Results Knowledge of guidelines and intention to implement them in practice was high. Key barriers to implementation were related to environmental context and resources and concern over potential consequences of implementing recommendations within the Nigerian context applicable for similar settings in low-to-middle-income countries. Conclusions The environmental context and limited resource setting of Nigerian hospitals currently presents a significant barrier to implementation of WHO and Sanford guidelines. Research and data collected from the local context must directly inform the writing of future international guidelines to increase rates of implementation.
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Affiliation(s)
- Caroline E. Wood
- UCL IRDR Centre for Digital Public Health in Emergencies, University College London, London, UK
- Corresponding author. E-mail: ; @PattyKostkova, @UCL_dPHE, @AnwarMusahAM, @LASUOfficial, @UnilagNigeria, @ekpoks, @suluedt, @DrCaroline_Wood
| | - Susanne Luedtke
- UCL IRDR Centre for Digital Public Health in Emergencies, University College London, London, UK
| | - Anwar Musah
- UCL IRDR Centre for Digital Public Health in Emergencies, University College London, London, UK
| | - Funmi Bammeke
- Department of Sociology, University of Lagos, Lagos, Nigeria
| | - Bamidele Mutiu
- Department of Medical Microbiology, Lagos State University College of Medicine/Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Rufus Ojewola
- Urology Unit, Department of Surgery, College of Medicine University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Olufemi Bankole
- Neurosurgery Unit, Department of Surgery, College of Medicine University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Adesoji Oludotun Ademuyiwa
- Paediatric Surgery Unit, Department of Surgery, College of Medicine University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | | | - Folasade Ogunsola
- Department of Medical Microbiology, Lagos State University College of Medicine/Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Patrick Okonji
- Department of Medical Microbiology, Lagos State University College of Medicine/Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Eneyi E. Kpokiri
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Department of Pharmacy, Niger Delta University Teaching Hospital, Bayelsa State, Nigeria
| | - Theophilus Ayibanoah
- Department of Pharmacy, Niger Delta University Teaching Hospital, Bayelsa State, Nigeria
| | - Neni Aworabhi-Oki
- Department of Surgery, Niger Delta University Teaching Hospital, Bayelsa State, Nigeria
| | - Laura Shallcross
- Institute of Health Informatics, University College London, London, UK
| | - Andreea Molnar
- School of Software and Electrical Engineering, Swinburne University of Technology, Melbourne, Australia
| | - Sue Wiseman
- UCL IRDR Centre for Digital Public Health in Emergencies, University College London, London, UK
| | - Andrew Hayward
- Institute of Epidemiology and Public Health, University College London, London, UK
| | - Delphine Soriano
- UCL IRDR Centre for Digital Public Health in Emergencies, University College London, London, UK
| | - Georgiana Birjovanu
- UCL IRDR Centre for Digital Public Health in Emergencies, University College London, London, UK
| | - Carmen Lefevre
- UCL Centre for Behaviour Change, University College London, London, UK
| | - Olajumoke Olufemi
- Department of Medical Microbiology, Lagos State University College of Medicine/Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Patty Kostkova
- UCL IRDR Centre for Digital Public Health in Emergencies, University College London, London, UK
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Elimian K, Musah A, King C, Igumbor E, Myles P, Aderinola O, Erameh C, Nwanchukwu W, Akande O, Nicaise N, Ogunbode O, Egwuenu A, Crawford E, Gaudenzi G, Abdus-Salam I, Olopha O, Disu Y, Bowale A, Oshoma C, Ohonsi C, Arinze C, Badaru S, Ebhodaghe B, Habib Z, Olugbile M, Dan-Nwafor C, Abubakar J, Pembi E, Dunkwu L, Ike I, Tobin E, Mutiu B, Luka-Lawal R, Nwafor O, Okowa M, Ezeokafor C, Iwara E, Yennan S, Eziechina S, Olatunji D, Falodun L, Joseph E, Abali I, Mohammed T, Yiga B, Kamaldeen K, Agogo E, Mba N, Oladejo J, Ilori E, Aruna O, Namara G, Obaro S, Hamza K, Asuzu M, Bello S, Okonofua F, Deeni Y, Abubakar I, Alfven T, Ochu C, Ihekweazu C. COVID-19 mortality rate and its associated factors during the first and second waves in Nigeria. PLOS Glob Public Health 2022; 2:e0000169. [PMID: 36962290 PMCID: PMC10022313 DOI: 10.1371/journal.pgph.0000169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 05/03/2022] [Indexed: 11/19/2022]
Abstract
COVID-19 mortality rate has not been formally assessed in Nigeria. Thus, we aimed to address this gap and identify associated mortality risk factors during the first and second waves in Nigeria. This was a retrospective analysis of national surveillance data from all 37 States in Nigeria between February 27, 2020, and April 3, 2021. The outcome variable was mortality amongst persons who tested positive for SARS-CoV-2 by Reverse-Transcriptase Polymerase Chain Reaction. Incidence rates of COVID-19 mortality was calculated by dividing the number of deaths by total person-time (in days) contributed by the entire study population and presented per 100,000 person-days with 95% Confidence Intervals (95% CI). Adjusted negative binomial regression was used to identify factors associated with COVID-19 mortality. Findings are presented as adjusted Incidence Rate Ratios (aIRR) with 95% CI. The first wave included 65,790 COVID-19 patients, of whom 994 (1∙51%) died; the second wave included 91,089 patients, of whom 513 (0∙56%) died. The incidence rate of COVID-19 mortality was higher in the first wave [54∙25 (95% CI: 50∙98-57∙73)] than in the second wave [19∙19 (17∙60-20∙93)]. Factors independently associated with increased risk of COVID-19 mortality in both waves were: age ≥45 years, male gender [first wave aIRR 1∙65 (1∙35-2∙02) and second wave 1∙52 (1∙11-2∙06)], being symptomatic [aIRR 3∙17 (2∙59-3∙89) and 3∙04 (2∙20-4∙21)], and being hospitalised [aIRR 4∙19 (3∙26-5∙39) and 7∙84 (4∙90-12∙54)]. Relative to South-West, residency in the South-South and North-West was associated with an increased risk of COVID-19 mortality in both waves. In conclusion, the rate of COVID-19 mortality in Nigeria was higher in the first wave than in the second wave, suggesting an improvement in public health response and clinical care in the second wave. However, this needs to be interpreted with caution given the inherent limitations of the country's surveillance system during the study.
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Affiliation(s)
- Kelly Elimian
- Nigeria Centre for Disease Control, Abuja, Nigeria
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Microbiology, Faculty of Life Sciences, University of Benin, Benin City, Edo State, Nigeria
- Nigeria COVID-19 Research Coalition, Abuja, Nigeria
| | - Anwar Musah
- Nigeria COVID-19 Research Coalition, Abuja, Nigeria
- Department of Geography, University College London, London, United Kingdom
| | - Carina King
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Ehimario Igumbor
- Nigeria Centre for Disease Control, Abuja, Nigeria
- Nigeria COVID-19 Research Coalition, Abuja, Nigeria
- Department of Geography, University College London, London, United Kingdom
| | - Puja Myles
- Clinical Practice Research Datalink, Medicines and Healthcare Products Regulatory Agency, London, United Kingdom
| | | | - Cyril Erameh
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | | | | | - Ndembi Nicaise
- Africa Centres for Disease Control and Prevention, Addis-Ababa, Ethiopia
| | | | | | | | - Giulia Gaudenzi
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Yahya Disu
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Abimbola Bowale
- Infectious Disease Unit, Mainland Hospital, Lagos, Lagos State, Nigeria
| | - Cyprian Oshoma
- Department of Microbiology, Faculty of Life Sciences, University of Benin, Benin City, Edo State, Nigeria
| | | | | | | | | | - Zaiyad Habib
- University of Abuja Teaching Hospital, Abuja, Nigeria
| | | | | | | | - Emmanuel Pembi
- Adamawa State Ministry of Health and Human Services, Yola, Adamawa State, Nigeria
| | - Lauryn Dunkwu
- Tony Blair Institute for Global Change, Abuja, Nigeria
| | - Ifeanyi Ike
- Nigeria Centre for Disease Control, Abuja, Nigeria
- eHealth Africa, Abuja, Nigeria
| | - Ekaete Tobin
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Bamidele Mutiu
- Lagos State Biobank Mainland Hospital Yaba, Lagos, Lagos State, Nigeria
| | | | | | | | - Chidiebere Ezeokafor
- Nigeria COVID-19 Research Coalition, Abuja, Nigeria
- National Agency for the Control of AIDS, Abuja, Nigeria
| | - Emem Iwara
- Maryland Global Initiatives Corporation, Abuja, Nigeria
| | | | | | | | - Lanre Falodun
- Department of Internal Medicine, National Hospital, Abuja, Nigeria
| | - Emmanuel Joseph
- Kaduna State Infectious Disease Control Centre, Kaduna, Kaduna State, Nigeria
| | | | | | - Benjamin Yiga
- Bauchi State Ministry of Health, Bauchi, Bauchi State, Nigeria
| | | | | | - Nwando Mba
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | - John Oladejo
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Elsie Ilori
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Olusola Aruna
- International Health Strengthening Project, Global Public Health, Public Health England, Abuja, Nigeria
| | | | - Stephen Obaro
- Department of Paediatrics, University of Nebraska, Lincoln, Nebraska, United States of America
| | - Khadeejah Hamza
- Nigeria COVID-19 Research Coalition, Abuja, Nigeria
- Department of Community Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Michael Asuzu
- Nigeria COVID-19 Research Coalition, Abuja, Nigeria
- University College Hospital, Ibadan, Oyo State, Nigeria
| | - Shaibu Bello
- Nigeria COVID-19 Research Coalition, Abuja, Nigeria
- College of Health Sciences, Usmanu Danfodiyo University, Sokoto, Sokoto State, Nigeria
| | - Friday Okonofua
- Centre of Excellence in Reproductive Health Innovation, University of Benin, Benin City, Edo State, Nigeria
| | - Yusuf Deeni
- Nigeria COVID-19 Research Coalition, Abuja, Nigeria
- Department of Microbiology and Biotechnology, Faculty of Science, Federal University Dutse, Dutse, Jigawa State, Nigeria
| | - Ibrahim Abubakar
- Institute for Global Health, Faculty of Pop Health Sciences, University College London, London, United Kingdom
| | - Tobias Alfven
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Chinwe Ochu
- Nigeria Centre for Disease Control, Abuja, Nigeria
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Elimian KO, Aderinola O, Gibson J, Myles P, Ochu CL, King C, Okwor T, Gaudenzi G, Olayinka A, Zaiyad HG, Ohonsi C, Ebhodaghe B, Dan-Nwafor C, Nwachukwu W, Abdus-Salam IA, Akande OW, Falodun O, Arinze C, Ezeokafor C, Jafiya A, Ojimba A, Aremu JT, Joseph E, Bowale A, Mutiu B, Saka B, Jinadu A, Hamza K, Ibeh C, Bello S, Asuzu M, Mba N, Oladejo J, Ilori E, Alfvén T, Igumbor E, Ihekweazu C. Assessing the capacity of symptom scores to predict COVID-19 positivity in Nigeria: a national derivation and validation cohort study. BMJ Open 2021; 11:e049699. [PMID: 34479936 PMCID: PMC8421116 DOI: 10.1136/bmjopen-2021-049699] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES This study aimed to develop and validate a symptom prediction tool for COVID-19 test positivity in Nigeria. DESIGN Predictive modelling study. SETTING All Nigeria States and the Federal Capital Territory. PARTICIPANTS A cohort of 43 221 individuals within the national COVID-19 surveillance dataset from 27 February to 27 August 2020. Complete dataset was randomly split into two equal halves: derivation and validation datasets. Using the derivation dataset (n=21 477), backward multivariable logistic regression approach was used to identify symptoms positively associated with COVID-19 positivity (by real-time PCR) in children (≤17 years), adults (18-64 years) and elderly (≥65 years) patients separately. OUTCOME MEASURES Weighted statistical and clinical scores based on beta regression coefficients and clinicians' judgements, respectively. Using the validation dataset (n=21 744), area under the receiver operating characteristic curve (AUROC) values were used to assess the predictive capacity of individual symptoms, unweighted score and the two weighted scores. RESULTS Overall, 27.6% of children (4415/15 988), 34.6% of adults (9154/26 441) and 40.0% of elderly (317/792) that had been tested were positive for COVID-19. Best individual symptom predictor of COVID-19 positivity was loss of smell in children (AUROC 0.56, 95% CI 0.55 to 0.56), either fever or cough in adults (AUROC 0.57, 95% CI 0.56 to 0.58) and difficulty in breathing in the elderly (AUROC 0.53, 95% CI 0.48 to 0.58) patients. In children, adults and the elderly patients, all scoring approaches showed similar predictive performance. CONCLUSIONS The predictive capacity of various symptom scores for COVID-19 positivity was poor overall. However, the findings could serve as an advocacy tool for more investments in resources for capacity strengthening of molecular testing for COVID-19 in Nigeria.
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Affiliation(s)
- Kelly Osezele Elimian
- Nigeria Centre for Disease Control, Abuja, Nigeria
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Jack Gibson
- Department of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Puja Myles
- Department of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | | | - Carina King
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Tochi Okwor
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Giulia Gaudenzi
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | | | | | | | | | | | | | - Oluwatosin Wuraola Akande
- Nigeria Centre for Disease Control, Abuja, Nigeria
- Department of Epidemiology and Community Health, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | | | | | | | | | | | | | - Emmanuel Joseph
- Kaduna State Infectious Disease Control Center Community Medicine, Kaduna, Nigeria
| | | | | | - Babatunde Saka
- Lagos State Government Ministry of Health, Ikeja, Nigeria
| | | | - Khadeejah Hamza
- Department of Community Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Christian Ibeh
- Department of Community Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | - Shaibu Bello
- Department of Medical Education, Usmanu Danfodiyo University, Sokoto, Nigeria
| | - Michael Asuzu
- Department of Community Medicine, University College Hospital, Ibadan, Nigeria
| | - Nwando Mba
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | - John Oladejo
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Elsie Ilori
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Tobias Alfvén
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Ehimario Igumbor
- Nigeria Centre for Disease Control, Abuja, Nigeria
- School of Public Health, University of the Western Cape, Bellville, South Africa
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7
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Abayomi A, Osibogun A, Kanma-Okafor O, Idris J, Bowale A, Wright O, Adebayo B, Balogun M, Ogboye S, Adeseun R, Abdus-Salam I, Mutiu B, Saka B, Lajide D, Yenyi S, Agbolagorite R, Onasanya O, Erinosho E, Obasanya J, Adejumo O, Adesola S, Oshodi Y, Akase IE, Ogunbiyi S, Omosun A, Erinoso F, Abdur-Razzaq H, Osa N, Akinroye K. Correction to: Morbidity and mortality outcomes of COVID-19 patients with and without hypertension in Lagos, Nigeria: a retrospective cohort study. Glob Health Res Policy 2021; 6:28. [PMID: 34389063 PMCID: PMC8360807 DOI: 10.1186/s41256-021-00215-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Akin Abayomi
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
| | - Akin Osibogun
- College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria. .,Lagos State Primary Health Care Board, Lagos, Nigeria.
| | | | - Jide Idris
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
| | | | - Ololade Wright
- Lagos State University College of Medicine, Lagos, Nigeria
| | - Bisola Adebayo
- Lagos State University College of Medicine, Lagos, Nigeria
| | | | - Segun Ogboye
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
| | - Remi Adeseun
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
| | - Ismael Abdus-Salam
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
| | | | | | - Dayo Lajide
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
| | - Sam Yenyi
- World Health Organization, Nigeria Office, Abuja, Nigeria
| | - Rotimi Agbolagorite
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
| | | | | | | | | | | | - Yewande Oshodi
- College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | | | | | - Adenike Omosun
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
| | - Femi Erinoso
- Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Hussein Abdur-Razzaq
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
| | - Nike Osa
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
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8
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Abayomi A, Osibogun A, Kanma-Okafor O, Idris J, Bowale A, Wright O, Adebayo B, Balogun M, Ogboye S, Adeseun R, Abdus-Salam I, Mutiu B, Saka B, Lajide D, Yenyi S, Agbolagorite R, Onasanya O, Erinosho E, Obasanya J, Adejumo O, Adesola S, Oshodi Y, Akase IE, Ogunbiyi S, Omosun A, Erinoso F, Abdur-Razzaq H, Osa N, Akinroye K. Morbidity and mortality outcomes of COVID-19 patients with and without hypertension in Lagos, Nigeria: a retrospective cohort study. Glob Health Res Policy 2021; 6:26. [PMID: 34325747 PMCID: PMC8319704 DOI: 10.1186/s41256-021-00210-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 06/20/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The current pandemic of coronavirus disease (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has shown epidemiological and clinical characteristics that appear worsened in hypertensive patients. The morbidity and mortality of the disease among hypertensive patients in Africa have yet to be well described. METHODS In this retrospective cohort study all confirmed COVID-19 adult patients (≥18 years of age) in Lagos between February 27 to July 62,020 were included. Demographic, clinical and outcome data were extracted from electronic medical records of patients admitted at the COVID-19 isolation centers in Lagos. Outcomes included dying, being discharged after recovery or being evacuated/transferred. Descriptive statistics considered proportions, means and medians. The Chi-square and Fisher's exact tests were used in determining associations between variables. Kaplan-Meier survival analysis and Cox regression were performed to quantify the risk of worse outcomes among hypertensives with COVID-19 and adjust for confounders. P-value ≤0.05 was considered statistically significant. RESULTS A total of 2075 adults with COVID-19 were included in this study. The prevalence of hypertension, the most common comorbidity, was 17.8% followed by diabetes (7.2%) and asthma (2.0%). Overall mortality was 4.2% while mortality among the hypertensives was 13.7%. Severe symptoms and mortality were significantly higher among the hypertensives and survival rates were significantly lowered by the presence of additional comorbidity to 50% from 91% for those with hypertension alone and from 98% for all other patients (P < 0.001). After adjustment for confounders (age and sex), severe COVID-19and death were higher for hypertensives {severe/critical illness: HR = 2.41, P = 0.001, 95%CI = 1.4-4.0, death: HR = 2.30, P = 0.001, 95%CI = 1.2-4.6, for those with hypertension only} {severe/critical illness: HR = 3.76, P = 0.001, 95%CI = 2.1-6.4, death: crude HR = 6.63, P = 0.001, 95%CI = 3.4-1.6, for those with additional comorbidities}. Hypertension posed an increased risk of severe morbidity (approx. 4-fold) and death (approx. 7-fold) from COVID-19 in the presence of multiple comorbidities. CONCLUSION The potential morbidity and mortality risks of hypertension especially with other comorbidities in COVID-19 could help direct efforts towards prevention and prognostication. This provides the rationale for improving preventive caution for people with hypertension and other comorbidities and prioritizing them for future antiviral interventions.
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Affiliation(s)
- Akin Abayomi
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
| | - Akin Osibogun
- College of Medicine University of Lagos, Idi-Araba, Lagos, Nigeria.
- Lagos State Primary Health Care Board, Lagos, Nigeria.
| | | | - Jide Idris
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
| | | | - Ololade Wright
- Lagos State University College of Medicine, Lagos, Nigeria
| | - Bisola Adebayo
- Lagos State University College of Medicine, Lagos, Nigeria
| | | | - Segun Ogboye
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
| | - Remi Adeseun
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
| | - Ismael Abdus-Salam
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
| | | | | | - Dayo Lajide
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
| | - Sam Yenyi
- World Health Organization, Nigeria Office, Abuja, Nigeria
| | - Rotimi Agbolagorite
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
| | | | | | | | | | | | - Yewande Oshodi
- College of Medicine University of Lagos, Idi-Araba, Lagos, Nigeria
| | | | | | - Adenike Omosun
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
| | - Femi Erinoso
- Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Hussein Abdur-Razzaq
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
| | - Nike Osa
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
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9
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Abayomi A, Balogun MR, Bankole M, Banke-Thomas A, Mutiu B, Olawepo J, Senjobi M, Odukoya O, Aladetuyi L, Ejekam C, Folarin A, Emmanuel M, Amodu F, Ologun A, Olusanya A, Bakare M, Alabi A, Abdus-Salam I, Erinosho E, Bowale A, Omilabu S, Saka B, Osibogun A, Wright O, Idris J, Ogunsola F. From Ebola to COVID-19: emergency preparedness and response plans and actions in Lagos, Nigeria. Global Health 2021; 17:79. [PMID: 34243790 PMCID: PMC8267235 DOI: 10.1186/s12992-021-00728-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 06/28/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Lagos state is the industrial nerve centre of Nigeria and was the epicentre of the 2014 Ebola outbreak in Nigeria as it is now for the current Coronavirus Disease (COVID-19) outbreak. This paper describes how the lessons learned from the Ebola outbreak in 2014 informed the emergency preparedness of the State ahead of the COVID-19 outbreak and guided response. DISCUSSION Following the Ebola outbreak in 2014, the Lagos State government provided governance by developing a policy on emergency preparedness and biosecurity and provided oversight and coordination of emergency preparedness strategies. Capacities for emergency response were strengthened by training key staff, developing a robust surveillance system, and setting up a Biosafety Level 3 laboratory and biobank. Resource provision, in terms of finances and trained personnel for emergencies was prioritized by the government. With the onset of COVID-19, Lagos state was able to respond promptly to the outbreak using the centralized Incident Command Structure and the key activities of the Emergency Operations Centre. Contributory to effective response were partnerships with the private sectors, community engagement and political commitment. CONCLUSION Using the lessons learned from the 2014 Ebola outbreak, Lagos State had gradually prepared its healthcare system for a pandemic such as COVID-19. The State needs to continue to expand its preparedness to be more resilient and future proof to respond to disease outbreaks. Looking beyond intra-state gains, lessons and identified best practices from the past and present should be shared with other states and countries.
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Affiliation(s)
- Akin Abayomi
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
- Lagos State Biosafety and Biosecurity Governing Council, Lagos, Nigeria
| | | | - Munir Bankole
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
| | | | - Bamidele Mutiu
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
| | - John Olawepo
- School of Public Health, University of Nevada, Las Vegas, USA
| | - Morakinyo Senjobi
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
| | | | - Lanre Aladetuyi
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
| | | | - Akinsanya Folarin
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
| | - Madonna Emmanuel
- College of Medicine University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Funke Amodu
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
| | - Adesoji Ologun
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
| | - Abosede Olusanya
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
| | - Moses Bakare
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
| | - Abiodun Alabi
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
| | - Ismail Abdus-Salam
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
- Lagos State Biosafety and Biosecurity Governing Council, Lagos, Nigeria
| | - Eniola Erinosho
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
| | - Abimbola Bowale
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
| | - Sunday Omilabu
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
- College of Medicine University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Babatunde Saka
- Lagos State Biosafety and Biosecurity Governing Council, Lagos, Nigeria
- Global Emerging Pathogens Treatment Consortium, Lagos, Nigeria
| | - Akin Osibogun
- Lagos State Biosafety and Biosecurity Governing Council, Lagos, Nigeria
- College of Medicine University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Ololade Wright
- Lagos State Biosafety and Biosecurity Governing Council, Lagos, Nigeria
| | - Jide Idris
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
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10
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Fadipe B, Oshodi YO, Umeh C, Aikomo K, Ajirotutu OF, Kajero J, Fashanu C, Adeoye AA, Coker AO, Sokunbi M, Nyamali VO, Ajomale T, Gbadebo A, Oni A, Keshinro AO, Ngozi Ejiegbu TA, Bowale A, Akase IE, Mutiu B, Adebayo B, Abdus-Salam I, Bode C, Osibogun A. Psychosocial health effects of Covid-19 infection on persons in treatment centers in Lagos, Nigeria. Brain Behav Immun Health 2021; 16:100284. [PMID: 34151305 PMCID: PMC8205258 DOI: 10.1016/j.bbih.2021.100284] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/28/2021] [Accepted: 05/28/2021] [Indexed: 12/24/2022] Open
Abstract
Introduction Prior research has highlighted the psychosocial impact of infectious diseases on individuals and the community at large. However, little is known about the psychosocial implications of COVID-19. This study set out to determine the rate as well as correlates of anxiety and depressive symptoms among persons managed as in-patients for COVID-19 in Lagos, Nigeria. Materials and methods We conducted an online survey between April to June ending 2020 using a consecutive sampling technique of persons positive for COVID-19 and who were managed as in-patients across five (5) treatment centres in Lagos, Nigeria. The survey collected information on demographic as well as clinical data including suicidality. Anxiety and depressive symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS). Results There were one hundred and sixty participants in total. The mean age of respondents was 36.4 (±9.7) years with a higher proportion (56.9%) being males. With regards to diagnosis, 28.1% and 27.5% of the respondents were categorised as probable cases of depression and anxiety respectively, while 3.8% respondents reported suicidal ideation. Majority of the respondents (61.9%) reported the fear of infecting their loved ones. The variables that showed association with psychiatric morbidity were a past history of an emotional concern, employment status, guilt about infecting others and boredom. Conclusion This study revealed a high burden of psychological/psychiatric morbidity among persons treated for COVID-19, particularly persons who have had prior emotional concerns. The findings from this study reiterate the need to pay attention to the mental health of people during disease outbreaks and to incorporate psychosocial interventions as part of the management package.
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Affiliation(s)
- Babatunde Fadipe
- Dept of Psychiatry, Lagos University Teaching Hospital (LUTH), Idi-Araba, Lagos, Nigeria
| | - Yewande O Oshodi
- Dept of Psychiatry, Lagos University Teaching Hospital (LUTH), Idi-Araba, Lagos, Nigeria
| | - Charles Umeh
- Dept of Psychiatry, Lagos University Teaching Hospital (LUTH), Idi-Araba, Lagos, Nigeria
| | - Kehinde Aikomo
- Dept of Medical Social Work, Lagos University Teaching Hospital (LUTH), Lagos, Nigeria
| | | | | | | | | | - Ayodele Olurotimi Coker
- Department of Psychiatry, Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos, Nigeria
| | | | | | - Tolu Ajomale
- Lagos State Ministry of Health, Ikeja, Lagos, Nigeria
| | | | - Adedapo Oni
- Dept of Psychiatry, Lagos University Teaching Hospital (LUTH), Idi-Araba, Lagos, Nigeria
| | | | | | | | - Iorhen E Akase
- Infectious Disease Unit, Department of Medicine, Lagos University Teaching Hospital (LUTH), Nigeria
| | - Bamidele Mutiu
- Lagos State Biobank, Mainland Hospital, Yaba, Lagos, Nigeria
| | - Bisola Adebayo
- Department of Community Health and Primary Care, Lagos State University, College of Medicine, Ikeja, Lagos, Nigeria
| | | | - Chris Bode
- Department of Surgery, Lagos University Teaching Hospital (LUTH), Lagos, Nigeria
| | - Akin Osibogun
- Department of Community Health and Primary Care, College of Medicine University of Lagos, Lagos, Nigeria
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11
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Osibogun A, Balogun M, Abayomi A, Idris J, Kuyinu Y, Odukoya O, Wright O, Adeseun R, Mutiu B, Saka B, Osa N, Lajide D, Abdus-Salam I, Osikomaiya B, Onasanya O, Adebayo B, Oshodi Y, Adesola S, Adejumo O, Erinoso O, Abdur-Razzaq H, Bowale A, Akinroye K. Outcomes of COVID-19 patients with comorbidities in southwest Nigeria. PLoS One 2021; 16:e0248281. [PMID: 33720975 PMCID: PMC7959379 DOI: 10.1371/journal.pone.0248281] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 02/23/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Data on the comorbidities that result in negative outcomes for people with COVID-19 are currently scarce for African populations. This study identifies comorbidities that predict death among a large sample of COVID-19 patients from Nigeria. METHODS This was a retrospective analysis of medical records for 2184 laboratory confirmed cases of COVID-19 in Lagos, southwest Nigeria. Extracted data included age, sex, severity of condition at presentation and self-reported comorbidities. The outcomes of interest were death or discharge from facility. RESULTS Most of the cases were male (65.8%) and the median age was 43 years (IQR: 33-55). Four hundred and ninety-two patients (22.5%) had at least one comorbidity and the most common amongst them were hypertension (74.2%) and diabetes (30.3%). The mortality rate was 3.3% and a significantly higher proportion of patients with comorbidities died compared to those with none. The comorbidities that predicted death were hypertension (OR: 2.21, 95%CI: 1.22-4.01), diabetes (OR: 3.69, 95% CI: 1.99-6.85), renal disease (OR: 12.53, 95%CI: 1.97-79.56), cancer (OR: 14.12, 95% CI: 2.03-98.19) and HIV (OR: 1.77-84.15]. CONCLUSION Comorbidities are prevalent and the associated risk of death is high among COVID-19 patients in Lagos, Nigeria. Public enlightenment, early identification and targeted care for COVID-19 cases with comorbidities are recommended as the pandemic evolves.
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Affiliation(s)
- Akin Osibogun
- Lagos State COVID-19 Incident Command System/Emergency Operation Centre, Lagos, Nigeria
- Department of Community Health and Primary Care, College of Medicine University of Lagos, Lagos, Nigeria
| | - Mobolanle Balogun
- Department of Community Health and Primary Care, College of Medicine University of Lagos, Lagos, Nigeria
| | - Akin Abayomi
- Lagos State COVID-19 Incident Command System/Emergency Operation Centre, Lagos, Nigeria
- Lagos State Ministry of Health, Lagos, Nigeria
| | - Jide Idris
- Lagos State COVID-19 Incident Command System/Emergency Operation Centre, Lagos, Nigeria
| | - Yetunde Kuyinu
- Department of Community Health and Primary Health Care, Lagos State University College of Medicine, Lagos, Nigeria
| | - Oluwakemi Odukoya
- Department of Community Health and Primary Care, College of Medicine University of Lagos, Lagos, Nigeria
| | - Ololade Wright
- Department of Community Health and Primary Health Care, Lagos State University College of Medicine, Lagos, Nigeria
| | - Remi Adeseun
- Lagos State COVID-19 Incident Command System/Emergency Operation Centre, Lagos, Nigeria
| | - Bamidele Mutiu
- Lagos State Biosafety and Biosecurity Governing Council, Lagos, Nigeria
| | - Babatunde Saka
- Lagos State Biosafety and Biosecurity Governing Council, Lagos, Nigeria
| | - Nike Osa
- Lagos State COVID-19 Incident Command System/Emergency Operation Centre, Lagos, Nigeria
| | - Dayo Lajide
- Lagos State COVID-19 Incident Command System/Emergency Operation Centre, Lagos, Nigeria
| | - Ismael Abdus-Salam
- Lagos State COVID-19 Incident Command System/Emergency Operation Centre, Lagos, Nigeria
| | - Bodunrin Osikomaiya
- Lagos State Blood Transfusion Service, Lagos State Ministry of Health, Lagos, Nigeria
| | | | - Bisola Adebayo
- Department of Community Health and Primary Health Care, Lagos State University College of Medicine, Lagos, Nigeria
| | - Yewande Oshodi
- Department of Psychiatry, College of Medicine University of Lagos, Lagos, Nigeria
| | | | | | - Olufemi Erinoso
- Department of Oral and Maxillofacial Surgery, Lagos State University Teaching Hospital, Ikeja, Nigeria
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12
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Iwalokun BA, Olalekan A, Adenipekun E, Ojo O, Iwalokun SO, Mutiu B, Orija O, Adegbola R, Salako B, Akinloye O. Improving the Understanding of the Immunopathogenesis of Lymphopenia as a Correlate of SARS-CoV-2 Infection Risk and Disease Progression in African Patients: Protocol for a Cross-sectional Study. JMIR Res Protoc 2021; 10:e21242. [PMID: 33621190 PMCID: PMC7935252 DOI: 10.2196/21242] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/05/2020] [Accepted: 11/10/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic, caused by SARS-CoV-2, continues to impact health systems throughout the world with serious medical challenges being imposed on many African countries like Nigeria. Although emerging studies have identified lymphopenia as a driver of cytokine storm, disease progression, and poor outcomes in infected patients, its immunopathogenesis, as well as environmental and genetic determinants, remain unclear. Understanding the interplay of these determinants in the context of lymphopenia and COVID-19 complications in patients in Africa may help with risk stratification and appropriate deployment of targeted treatment regimens with repurposed drugs to improve prognosis. OBJECTIVE This study is designed to investigate the role of vitamin D status, vasculopathy, apoptotic pathways, and vitamin D receptor (VDR) gene polymorphisms in the immunopathogenesis of lymphopenia among African people infected with SARS-CoV-2. METHODS This cross-sectional study will enroll 230 participants, categorized as "SARS-CoV-2 negative" (n=69), "COVID-19 mild" (n=32), "hospitalized" (n=92), and "recovered" (n=37), from two health facilities in Lagos, Nigeria. Sociodemographic data, travel history, and information on comorbidities will be obtained from case files and through a pretested, interview-based structured questionnaire. Venous blood samples (5 mL) collected between 8 AM and 10 AM and aliquoted into EDTA (ethylenediaminetetraacetic acid) and plain tubes will be used for complete blood count and CD4 T cell assays to determine lymphopenia (lymphocyte count <1000 cells/µL) and CD4 T lymphocyte levels, as well as to measure the concentrations of vitamin D, caspase 3, soluble vascular cell adhesion molecule-1 (sVCAM-1), and soluble Fas ligand (sFasL) using an autoanalyzer, flow cytometry, and ELISA (enzyme-linked immunosorbent assay) techniques. Genomic DNA will be extracted from the buffy coat and used as a template for the amplification of apoptosis-related genes (Bax, Bcl-2, BCL2L12) by polymerase chain reaction (PCR) and genotyping of VDR (Apa1, Fok1, and Bsm1) gene polymorphisms by the PCR restriction fragment length polymorphism method and capillary sequencing. Total RNA will also be extracted, reverse transcribed, and subsequently quantitated by reverse transcription PCR (RT-PCR) to monitor the expression of apoptosis genes in the four participant categories. Data analyses, which include a test of association between VDR gene polymorphisms and study outcomes (lymphopenia and hypovitaminosis D prevalence, mild/moderate and severe infections) will be performed using the R statistical software. Hardy-Weinberg equilibrium and linkage disequilibrium analyses for the alleles, genotypes, and haplotypes of the genotyped VDR gene will also be carried out. RESULTS A total of 45 participants comprising 37 SARS-CoV-2-negative and 8 COVID-19-recovered individuals have been enrolled so far. Their complete blood counts and CD4 T lymphocyte counts have been determined, and their serum samples and genomic DNA and RNA samples have been extracted and stored at -20 °C until further analyses. Other expected outcomes include the prevalence and distribution of lymphopenia and hypovitaminosis D in the control (SARS-CoV-2 negative), confirmed, hospitalized, and recovered SARS-CoV-2-positive participants; association of lymphopenia with CD4 T lymphocyte level, serum vitamin D, sVCAM-1, sFasL, and caspase 3 levels in hospitalized patients with COVID-19; expression levels of apoptosis-related genes among hospitalized participants with COVID-19, and those with lymphopenia compared to those without lymphopenia; and frequency distribution of the alleles, genotypes, and haplotypes of VDR gene polymorphisms in COVID-19-infected participants. CONCLUSIONS This study will aid in the genotypic and phenotypic stratification of COVID-19-infected patients in Nigeria with and without lymphopenia to enable biomarker discovery and pave the way for the appropriate and timely deployment of patient-centered treatments to improve prognosis. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/21242.
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Affiliation(s)
| | - Adesola Olalekan
- Department of Medical Laboratory Sciences, Faculty of Basic Medical Science, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Eyitayo Adenipekun
- Department of Medical Laboratory Sciences, Faculty of Basic Medical Science, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Olabisi Ojo
- Department of Natural Sciences, Albany State University, Georgia, GA, United States
| | | | - Bamidele Mutiu
- Department of Medical Microbiology & Parasitology, College of Medicine, Lagos State University, Lagos, Nigeria
| | - Oluseyi Orija
- Department of Public Health, National University, San Diego, CA, United States
| | - Richard Adegbola
- Microbiology Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | | | - Oluyemi Akinloye
- Department of Medical Laboratory Sciences, Faculty of Basic Medical Science, College of Medicine, University of Lagos, Lagos, Nigeria
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Abayomi A, Odukoya O, Osibogun A, Wright O, Adebayo B, Balogun M, Abdus-Salam I, Bowale A, Mutiu B, Saka B, Adejumo M, Yenyi S, Agbolagorite R, Onasanya O, Erinosho E, Obasanya J, Adejumo O, Adesola S, Oshodi Y, Akase IE, Ogunbiyi S, Lajide D, Erinoso F, Abdur-Razzaq H. Presenting Symptoms and Predictors of Poor Outcomes Among 2,184 Patients with COVID-19 in Lagos State, Nigeria. Int J Infect Dis 2021; 102:226-232. [PMID: 33075534 PMCID: PMC7566672 DOI: 10.1016/j.ijid.2020.10.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/06/2020] [Accepted: 10/08/2020] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Lagos state remains the epicentre of COVID-19 in Nigeria. We describe the symptoms and signs of the first 2,184 PCR-confirmed COVID-19 patients admitted at COVID-19 treatment centers in Lagos State. We also assessed the relationship between patients' presenting symptoms, sociodemographic and clinical characteristics and COVID-19 deaths.. METHODS Medical records of PCR-confirmed COVID-19 patients were extracted and analyzed for their symptoms, symptom severity, presence of comorbidities and outcome. RESULTS The ages of the patients ranged from 4 days to 98 years with a mean of 43.0(16.0) years. Of the patients who presented with symptoms, cough (19.3%) was the most common presenting symptom. This was followed by fever (13.7%) and difficulty in breathing, (10.9%). The most significant clinical predictor of death was the severity of symptoms and signs at presentation. Difficulty in breathing was the most significant symptom predictor of COVID-19 death (OR:19.26 95% CI 10.95-33.88). The case fatality rate was 4.3%. CONCLUSION Primary care physicians and COVID-19 frontline workers should maintain a high index of suspicion and prioritize the care of patients presenting with these symptoms. Community members should be educated on such predictors and ensure that patients with these symptoms seek care early to reduce the risk of deaths associated with COVID-19.
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Affiliation(s)
| | | | - Akin Osibogun
- College of Medicine University of Lagos; Lagos State Primary Health Care Board; Lagos University Teaching Hospital.
| | | | | | | | | | | | | | | | | | - Sam Yenyi
- World Health Organization, Nigeria Office
| | | | | | | | | | | | | | - Yewande Oshodi
- College of Medicine University of Lagos; Lagos University Teaching Hospital
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14
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Otuonye NM, Olumade TJ, Ojetunde MM, Holdbrooke SA, Ayoola JB, Nyam IY, Iwalokun B, Onwuamah C, Uwandu M, Abayomi A, Osibogun A, Bowale A, Osikomaiya B, Thomas B, Mutiu B, Odunukwe NN. Clinical and Demographic Characteristics of COVID-19 patients in Lagos, Nigeria: A Descriptive Study. J Natl Med Assoc 2020; 113:301-306. [PMID: 33358220 PMCID: PMC7759120 DOI: 10.1016/j.jnma.2020.11.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 10/06/2020] [Accepted: 11/27/2020] [Indexed: 12/18/2022]
Abstract
Introduction COVID-19 is an emerging, rapidly evolving global situation, infecting over 25 million people and causing more than 850,000 deaths. Several signs and symptoms have been described to be characteristic of the disease. However, there is a dearth of report on the description of the clinical characteristics of the disease in patients from Nigeria. This study was designed to provide a description of the clinical and demographic characteristics of COVID-19 patients in Nigeria. Methods This study is a case series that includes patients that are evaluated between May and August 2020, and diagnosed with COVID-19. Patient health records were reviewed and evaluated to describe the clinical characteristics on presentation. Results A total of 154 COVID-19 patients were included in this study, with a mean age (S.D.) of 46.16 (13.701). Most of the patients survived (mortality rate of 2.6%), and were symptomatic (89.6%). There were more males (74.7%) than females, and the most common symptoms were fever, breathing difficulty, dry cough and malaise. Co-morbidities were also present in almost half of the study participants (49.4%). Conclusion This study presents the most extensive description, to date, on the clinical and demographic characteristics of COVID-19 patients in Nigeria. Males are more likely than females to be infected with COVID-19 and the most occurring symptoms are fever, breathing difficulty, malaise, dry cough and chest pain. Old age and the presence of co-morbidities may also be associated with developing the severe disease.
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Affiliation(s)
| | - Testimony Jesupamilerin Olumade
- Department of Biological Sciences, Redeemer's University, Ede, Osun state; African Centre of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Osun state
| | | | | | | | - Itse Yusuf Nyam
- Central Research Laboratory, Nigerian Institute of Medical Research, Yaba, Lagos
| | - Bamidele Iwalokun
- Molecular Biological and Biotechnology Department, Nigerian Institute of Medical Research, Yaba, Lagos
| | - Chika Onwuamah
- Centre for Human Virology and Genomics, Nigerian Institute of Medical Research, Yaba, Lagos
| | - Mabel Uwandu
- Centre for Human Virology and Genomics, Nigerian Institute of Medical Research, Yaba, Lagos
| | - Akinola Abayomi
- Lagos State Ministry of Health, Alausa, Ikeja, Lagos, Nigeria
| | - Akin Osibogun
- College of Medicine University of Lagos, Nigeria; Lagos State Primary Health Care Board, Lagos, Nigeria
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15
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Erinoso OA, Wright KO, Anya S, Bowale A, Adejumo O, Adesola S, Osikomaiya B, Mutiu B, Saka B, Falana A, Ola-Ayinde D, Akase EI, Owuna H, Abdur-Razzaq H, Lajide D, Ezechi O, Ogboye O, Osibogun A, Abayomi A. Clinical characteristics, predictors of symptomatic coronavirus disease 2019 and duration of hospitalisation in a cohort of 632 Patients in Lagos State, Nigeria. Niger Postgrad Med J 2020; 27:285-292. [PMID: 33154280 DOI: 10.4103/npmj.npmj_272_20] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The clinical spectrum of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is still evolving. This study describes the clinical characteristics and investigates factors that predict symptomatic presentation and duration of hospitalisation in a cohort of coronavirus disease 2019 (COVID-19) patients managed in Lagos, Nigeria. METHODOLOGY This was a retrospective assessment of patients hospitalised with COVID-19 disease in six dedicated facilities in Lagos, Nigeria, between April 1st and May 31st 2020. Participants were individuals with laboratory-confirmed SARS-CoV-2 infection. The outcome measures were presence of symptoms and duration of hospitalisation. Demographic and comorbidity data were also obtained. Statistical analysis was done using STATA 15.0 software, with P < 0.05 being considered statistically significant. RESULTS A total of 632 cases were analysed. The median age was 40 years (IQR: 30.5-49); male patients accounted for 60.1%. About 63% of patients were asymptomatic at presentation. Among the symptomatic, the most common symptoms were cough (47.4%) and fever (39.7%). The most common comorbidities were hypertension (16.8%) and diabetes (5.2%). The median duration of hospitalisation was 10 days (IQR: 8-14). Comorbidities increased the odds of presenting with symptoms 1.6-fold (P = 0.025) for one comorbidity and 3.2-fold (P = 0.005) for ≥2 comorbidities. Individuals aged ≥50 years were twice as likely to be hospitalised for more than 14 days compared to individuals aged <50 years (P = 0.016). CONCLUSION Most individuals had no symptoms with comorbidities increasing the likelihood of symptoms. Older age was associated with longer duration of hospitalisation. Age and comorbidities should be used for COVID-19 triaging for efficient resource allocation.
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Affiliation(s)
- Olufemi A Erinoso
- Department of Oral and Maxillofacial Surgery, Lagos State University Teaching Hospital, Lagos State, Lagos, Nigeria
| | - Kikelomo Ololade Wright
- Department of Community Health and Primary Health Care, Lagos State University Teaching Hospital, Lagos State, Lagos, Nigeria
| | - Samuel Anya
- Research Unit, Directorate of Health Planning Research and Statistics Lagos State Ministry of Health, Lagos State, Lagos, Nigeria
| | - Abimbola Bowale
- Infectious Disease Unit, Mainland Hospital, Lagos State, Lagos, Nigeria
| | - Olusola Adejumo
- Research Unit, Directorate of Health Planning Research and Statistics Lagos State Ministry of Health, Lagos State, Lagos, Nigeria
| | - Sunday Adesola
- Infectious Disease Unit, Mainland Hospital, Lagos State, Lagos, Nigeria
| | | | - Bamidele Mutiu
- Lagos State Bio-Security Laboratory, Mainland Hospital Yaba, Lagos State, Lagos, Nigeria
| | - Babatunde Saka
- Lagos State Bio-Security Laboratory, Mainland Hospital Yaba, Lagos State, Lagos, Nigeria
| | - Ayodeji Falana
- Infectious Disease Unit, Mainland Hospital, Lagos State, Lagos, Nigeria
| | - Disu Ola-Ayinde
- Infectious Disease Unit, Mainland Hospital, Lagos State, Lagos, Nigeria
| | - Ephraim I Akase
- Department of Medicine, Infectious Disease Unit, Lagos University Teaching Hospital, Lagos State, Lagos, Nigeria
| | - Henry Owuna
- Infectious Disease Unit, Mainland Hospital, Lagos State, Lagos, Nigeria
| | - Hussein Abdur-Razzaq
- Research Unit, Directorate of Health Planning Research and Statistics Lagos State Ministry of Health, Lagos State, Lagos, Nigeria
| | - Dayo Lajide
- Research Unit, Directorate of Health Planning Research and Statistics Lagos State Ministry of Health, Lagos State, Lagos, Nigeria
| | - Oliver Ezechi
- Directorate of Research, Institute of Medical Research, Lagos State, Lagos, Nigeria
| | | | - Akin Osibogun
- Department of Community and Primary Health, College of Medicine, University of Lagos, Lagos, Nigeria
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16
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Ohuabunwo C, Ameh C, Oduyebo O, Ahumibe A, Mutiu B, Olayinka A, Gbadamosi W, Garcia E, Nanclares C, Famiyesin W, Mohammed A, Nguku P, Koko RI, Obasanya J, Adebayo D, Gbadegesin Y, Idigbe O, Oguntimehin O, Nyanti S, Nzuki C, Abdus-Salam I, Adeyemi J, Onyekwere N, Musa E, Brett-Major D, Shuaib F, Nasidi A. MERS. Int J Infect Dis 2016. [PMID: 27575939 PMCID: PMC7129421 DOI: 10.1016/j.ijid.2016.11.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Chima Ohuabunwo
- African Field Epidemiology Network, Kampala, Uganda; Department of Medicine, Morehouse School of Medicine, 720 West View Drive SW, Atlanta, GA 30310, USA.
| | - Celestine Ameh
- Nigeria Field Epidemiology and Laboratory Training Program, Abuja, Nigeria
| | - Oyin Oduyebo
- College of Medicine, University of Lagos, Lagos, Nigeria
| | - Anthony Ahumibe
- Nigeria Field Epidemiology and Laboratory Training Program, Abuja, Nigeria
| | - Bamidele Mutiu
- Lagos State University Teaching Hospital, Ikeja, Nigeria
| | - Adebola Olayinka
- Nigeria Field Epidemiology and Laboratory Training Program, Abuja, Nigeria; College of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | | | | | | | - Wale Famiyesin
- World Health Organization Country Office, Abuja, Nigeria
| | - Abdulaziz Mohammed
- Nigeria Field Epidemiology and Laboratory Training Program, Abuja, Nigeria
| | - Patrick Nguku
- African Field Epidemiology Network, Kampala, Uganda; Nigeria Field Epidemiology and Laboratory Training Program, Abuja, Nigeria
| | - Richard I Koko
- World Health Organization Country Office, Abuja, Nigeria
| | | | | | | | - Oni Idigbe
- Nigeria Institute of Medical Research, Yaba, Lagos, Nigeria
| | | | | | | | | | - Joseph Adeyemi
- Department of Psychiatry, University of Lagos, Lagos, Nigeria
| | | | - Emmanuel Musa
- World Health Organization Country Office, Abuja, Nigeria
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