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Onwuamah CK, Feng N, Momoh AE, Uwandu M, Ahmed RA, Idigbe I, Vincent GD, Ogbu CA, Okonkwo N, Sokei J, Abimbola BS, Ojopagogo T, Okoli LC, Adesina M, Ezemelue PN, Sowunmi O, Okwuzu J, Labo−Popoola OH, Shaibu JO, Ohihoin GA, Nzeribe E, David A, Olaleye O, Ofotokun I, Dong X, Ezechi OC. Prevalence and risk factors for high-risk human papillomavirus infection among women from three southern geopolitical zones of Nigeria. Front Oncol 2023; 13:1254304. [PMID: 37876969 PMCID: PMC10593479 DOI: 10.3389/fonc.2023.1254304] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/19/2023] [Indexed: 10/26/2023] Open
Abstract
Introduction Human Papillomavirus (HPV) infection is a risk factor for cervical cancer, the fourth most common cancer among women globally. Its burden is the highest in sub-Saharan Africa, with over 90% mortality. Interventions may fail without evidence-based data on stratified prevalence and risk factors among most at-risk women across Nigeria. Methods A cross-sectional comparative study, with participants recruited from the Nigerian Institute of Medical Research's Clinics, NGO outreaches, a cancer screening centre and a university teaching hospital. Questionnaires were self-administered. Trained medics performed sampling at healthcare facilities, and self-sampling was used at outreaches. Results Nine hundred eighty-five study participants were recruited. About 37% and 27% of the women knew about HPV and its vaccines, respectively, but only 6% confirmed vaccination with HPV vaccines. HPV prevalence was highest among women with unknown marital status (35.9%), single women (33.8%), widowed/divorced/separated women (30.3%), and married/cohabiting women (19.6%). HPV infection was significantly higher among women who take alcohol (odds=1.7 [95% CI: 1.2-2.4]) and women who smoke (odds=2.6 [95% CI: 1.4 - 4.6]. HPV strains detected included HPV16 (1.3%), HPV18 (1.5%), Low Risk (0.2%) and Other High-Risk groups (19.7%). Conclusion The inverse relationship between prevalence and education suggests interventions improving awareness and prevention would be impactful. Such interventions could also target HIV-positive women, women presenting with sexually-transmitted infections, who smoke and frequently drink alcohol.
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Affiliation(s)
- Chika Kingsley Onwuamah
- Centre for Human Virology and Genomics, Department of Microbiology, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Ning Feng
- Center for Global Public Health, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Abidemi Esther Momoh
- Centre for Human Virology and Genomics, Department of Microbiology, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Mabel Uwandu
- Centre for Human Virology and Genomics, Department of Microbiology, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Rahaman Ademolu Ahmed
- Centre for Human Virology and Genomics, Department of Microbiology, Nigerian Institute of Medical Research, Lagos, Nigeria
- Division of Allergy and Clinical Immunology, Division of Genetics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Ifeoma Idigbe
- Centre for Reproduction and Population Health Studies, Department of Clinical Sciences, Nigeria Institute Medical Research, Lagos, Nigeria
| | - Grace Deborah Vincent
- Centre for Human Virology and Genomics, Department of Microbiology, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Chinenye Angela Ogbu
- Centre for Human Virology and Genomics, Department of Microbiology, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Nkem Okonkwo
- Department of Obstetrics and Gynaecology, Delta State University Teaching Hospital, Oghara, Delta, Nigeria
| | - Judith Sokei
- Centre for Human Virology and Genomics, Department of Microbiology, Nigerian Institute of Medical Research, Lagos, Nigeria
- Department of Pediatric Oncology (Hematology), Washington University in St. Louis, St. Louis, MO, United States
| | - Bowofoluwa Sharon Abimbola
- Centre for Human Virology and Genomics, Department of Microbiology, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Temiloluwa Ojopagogo
- Centre for Human Virology and Genomics, Department of Microbiology, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Leona Chika Okoli
- Centre for Human Virology and Genomics, Department of Microbiology, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Mary Adesina
- Centre for Human Virology and Genomics, Department of Microbiology, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Priscilla Ngozi Ezemelue
- Centre for Reproduction and Population Health Studies, Department of Clinical Sciences, Nigeria Institute Medical Research, Lagos, Nigeria
| | - Omowunmi Sowunmi
- Centre for Human Virology and Genomics, Department of Microbiology, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Jane Okwuzu
- Centre for Reproduction and Population Health Studies, Department of Clinical Sciences, Nigeria Institute Medical Research, Lagos, Nigeria
| | - Olaoniye Habeebat Labo−Popoola
- Centre for Human Virology and Genomics, Department of Microbiology, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Joseph Ojonugwa Shaibu
- Centre for Human Virology and Genomics, Department of Microbiology, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Greg Aigbe Ohihoin
- Centre for Reproduction and Population Health Studies, Department of Clinical Sciences, Nigeria Institute Medical Research, Lagos, Nigeria
| | - Emily Nzeribe
- Department of Obstetrics and Gynaecology, Federal Medical Centre, Owerri, Imo, Nigeria
| | - Agatha David
- Centre for Reproduction and Population Health Studies, Department of Clinical Sciences, Nigeria Institute Medical Research, Lagos, Nigeria
| | - Olufemi Olaleye
- Screening Section, Optimal Cancer Care Foundation Centre, Lagos, Nigeria
| | - Ighovwerha Ofotokun
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Xiao−ping Dong
- Center for Global Public Health, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Oliver Chukwujekwu Ezechi
- Centre for Reproduction and Population Health Studies, Department of Clinical Sciences, Nigeria Institute Medical Research, Lagos, Nigeria
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Iriemenam NC, Ige FA, Greby SM, Okunoye OO, Uwandu M, Aniedobe M, Nwaiwu SO, Mba N, Okoli M, William NE, Ehoche A, Mpamugo A, Mitchell A, Stafford KA, Thomas AN, Olaleye T, Akinmulero OO, Agala NP, Abubakar AG, Owens A, Gwyn SE, Rogier E, Udhayakumar V, Steinhardt LC, Martin DL, Okoye MI, Audu R. Comparison of one single-antigen assay and three multi-antigen SARS-CoV-2 IgG assays in Nigeria. J Clin Virol Plus 2023; 3:100139. [PMID: 36683611 PMCID: PMC9837382 DOI: 10.1016/j.jcvp.2023.100139] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/03/2022] [Accepted: 01/12/2023] [Indexed: 01/14/2023] Open
Abstract
Objectives Determining an accurate estimate of SARS-CoV-2 seroprevalence has been challenging in African countries where malaria and other pathogens are endemic. We compared the performance of one single-antigen assay and three multi-antigen SARS-CoV-2 IgG assays in a Nigerian population endemic for malaria. Methods De-identified plasma specimens from SARS-CoV-2 RT-PCR positive, dried blood spot (DBS) SARS-CoV-2 RT-PCR positive, and pre-pandemic negatives were used to evaluate the performance of the four SARS-CoV-2 assays (Tetracore, SARS2MBA, RightSign, xMAP). Results Results showed higher sensitivity with the multi-antigen (81% (Tetracore), 96% (SARS2MBA), 85% (xMAP)) versus the single-antigen (RightSign (64%)) SARS-CoV-2 assay. The overall specificities were 98% (Tetracore), 100% (SARS2MBA and RightSign), and 99% (xMAP). When stratified based on <15 days to ≥15 days post-RT-PCR confirmation, the sensitivities increased from 75% to 88.2% for Tetracore; from 93% to 100% for the SARS2MBA; from 58% to 73% for RightSign; and from 83% to 88% for xMAP. With DBS, there was no positive increase after 15-28 days for the three assays (Tetracore, SARS2MBA, and xMAP). Conclusion Multi-antigen assays performed well in Nigeria, even with samples with known malaria reactivity, and might provide more accurate measures of COVID-19 seroprevalence and vaccine efficacy.
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Affiliation(s)
- Nnaemeka C Iriemenam
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Fehintola A Ige
- Center for Human Virology and Genomics, Microbiology Department, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Stacie M Greby
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Olumide O Okunoye
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Mabel Uwandu
- Center for Human Virology and Genomics, Microbiology Department, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Maureen Aniedobe
- Center for Human Virology and Genomics, Microbiology Department, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Stephnie O Nwaiwu
- Center for Human Virology and Genomics, Microbiology Department, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Nwando Mba
- Nigeria Centre for Disease Control (NCDC), Gaduwa, FCT, Nigeria
| | - Mary Okoli
- Nigeria Centre for Disease Control (NCDC), Gaduwa, FCT, Nigeria
| | | | - Akipu Ehoche
- University of Maryland Center for International Health, Education, and Biosecurity (CIHEB), Maryland Global Initiatives Corporation (MGIC), FCT, Nigeria
| | - Augustine Mpamugo
- University of Maryland Center for International Health, Education, and Biosecurity (CIHEB), Maryland Global Initiatives Corporation (MGIC), FCT, Nigeria
| | - Andrew Mitchell
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA
| | - Kristen A Stafford
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA
| | - Andrew N Thomas
- International Research Center of Excellence, Institute of Human Virology, Abuja, Nigeria
| | - Temitope Olaleye
- International Research Center of Excellence, Institute of Human Virology, Abuja, Nigeria
| | - Oluwaseun O Akinmulero
- International Research Center of Excellence, Institute of Human Virology, Abuja, Nigeria
| | - Ndidi P Agala
- International Research Center of Excellence, Institute of Human Virology, Abuja, Nigeria
| | - Ado G Abubakar
- International Research Center of Excellence, Institute of Human Virology, Abuja, Nigeria
| | - Ajile Owens
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sarah E Gwyn
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Eric Rogier
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Venkatachalam Udhayakumar
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Laura C Steinhardt
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Diana L Martin
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - McPaul I Okoye
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Rosemary Audu
- Center for Human Virology and Genomics, Microbiology Department, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
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Feng N, Ezechi O, Uwandu M, Abimbola BS, Vincent GD, Idigbe I, Okoli LC, Adesina M, Okwuzu J, Ahmed RA, Sokei J, Shaibu JO, Momoh AE, Sowunmi O, Labo-Popoola OH, Ohihoin G, David A, Nzeribe E, Olaleye O, Dong XP, Onwuamah CK. Self-collected versus medic-collected sampling for human papillomavirus testing among women in Lagos, Nigeria: a comparative study. BMC Public Health 2022; 22:1922. [PMID: 36243709 PMCID: PMC9569041 DOI: 10.1186/s12889-022-14222-5] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 09/12/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To evaluate the feasibility and performance of self-collected vaginal swab samples for HPV screening among women in Lagos, Nigeria. METHODS A cross-sectional study was implemented from March to August 2020 among sexually active women. Study participants provided same-day paired vaginal swab samples. Medic-sampling and poster-directed self-sampling methods were used to collect the two samples per participant. A real-time PCR assay detected HPV 16, HPV 18, other-high-risk (OHR) HPV, and the human β-globin gene. The self-collected samples' sensitivity, specificity, and accuracy were determined against the medic-collected samples using the MedCalc Online Diagnostic Calculator. RESULTS Of the 213 women aged 16 ~ 63-year-old recruited, 187 (88%) participants had concordant results, while 26 (12%) participants had discordant results. Among the 187 concordant results, 35 (19%) were HPV positive, 150 (80%) participants were HPV negative, and two (1%) were invalid. 18 (69%) out of the 26 discordant samples were invalid. The self-collected sample was invalid for 14 (54%) participants. Two (8%) medic-collected samples were invalid. Compared to the medic-collected sample, the self-collected sample was 89.80% (95% CI: 77.77 ~ 96.60%) sensitive and 98.21% (95% CI: 94.87 ~ 99.63%) specific, with an accuracy of 96.31% (95% CI: 92.87 ~ 98.40%). The mean age for HPV positive and negative participants were 39 and 40, respectively, with an ANOVA p-value of 0.3932. The stratification of HPV infection by the age group was not statistically significant (P > 0.05). CONCLUSIONS With high accuracy of 96%, self-collected sampling is adequate when tested with real-time PCR and may increase the uptake of HPV testing. Though more self-collected samples were invalid than medic-collected samples, most likely due to poor collection, they could be identified for repeat testing. Future implementation can avoid this error with improved guidance and awareness.
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Affiliation(s)
- Ning Feng
- Center for Global Public Health, Chinese Centre for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, China
| | - Oliver Ezechi
- Department of Clinical Sciences, Nigerian Institute of Medical Research, 6 Edmund Crescent, Yaba, Lagos, Nigeria
| | - Mabel Uwandu
- Centre for Human Virology and Genomics, Department of Microbiology, Nigerian Institute of Medical Research, 6 Edmund Crescent, Yaba, Lagos, Nigeria
| | - Bowofoluwa Sharon Abimbola
- Centre for Human Virology and Genomics, Department of Microbiology, Nigerian Institute of Medical Research, 6 Edmund Crescent, Yaba, Lagos, Nigeria
| | - Grace Deborah Vincent
- Centre for Human Virology and Genomics, Department of Microbiology, Nigerian Institute of Medical Research, 6 Edmund Crescent, Yaba, Lagos, Nigeria
| | - Ifeoma Idigbe
- Department of Clinical Sciences, Nigerian Institute of Medical Research, 6 Edmund Crescent, Yaba, Lagos, Nigeria
| | - Leona Chika Okoli
- Centre for Human Virology and Genomics, Department of Microbiology, Nigerian Institute of Medical Research, 6 Edmund Crescent, Yaba, Lagos, Nigeria
| | - Mary Adesina
- Centre for Human Virology and Genomics, Department of Microbiology, Nigerian Institute of Medical Research, 6 Edmund Crescent, Yaba, Lagos, Nigeria
| | - Jane Okwuzu
- Department of Clinical Sciences, Nigerian Institute of Medical Research, 6 Edmund Crescent, Yaba, Lagos, Nigeria
| | - Rahaman Ademolu Ahmed
- Centre for Human Virology and Genomics, Department of Microbiology, Nigerian Institute of Medical Research, 6 Edmund Crescent, Yaba, Lagos, Nigeria
| | - Judith Sokei
- Centre for Human Virology and Genomics, Department of Microbiology, Nigerian Institute of Medical Research, 6 Edmund Crescent, Yaba, Lagos, Nigeria
| | - Joseph Ojonugwa Shaibu
- Centre for Human Virology and Genomics, Department of Microbiology, Nigerian Institute of Medical Research, 6 Edmund Crescent, Yaba, Lagos, Nigeria
| | - Abidemi Esther Momoh
- Centre for Human Virology and Genomics, Department of Microbiology, Nigerian Institute of Medical Research, 6 Edmund Crescent, Yaba, Lagos, Nigeria
| | - Omowunmi Sowunmi
- Centre for Human Virology and Genomics, Department of Microbiology, Nigerian Institute of Medical Research, 6 Edmund Crescent, Yaba, Lagos, Nigeria
| | - Olaoniye Habeebat Labo-Popoola
- Centre for Human Virology and Genomics, Department of Microbiology, Nigerian Institute of Medical Research, 6 Edmund Crescent, Yaba, Lagos, Nigeria
| | | | - Greg Ohihoin
- Department of Clinical Sciences, Nigerian Institute of Medical Research, 6 Edmund Crescent, Yaba, Lagos, Nigeria
| | - Agatha David
- Department of Clinical Sciences, Nigerian Institute of Medical Research, 6 Edmund Crescent, Yaba, Lagos, Nigeria
| | - Emily Nzeribe
- Federal Medical Centre, 105 Orlu Road, Owerri, Imo State, Nigeria
| | | | - Xiao-Ping Dong
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, China.
| | - Chika Kingsley Onwuamah
- Centre for Human Virology and Genomics, Department of Microbiology, Nigerian Institute of Medical Research, 6 Edmund Crescent, Yaba, Lagos, Nigeria.
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Samuel Amoo O, Awoderu O, Yisau J, Oladele D, David AN, Raheem T, Uwandu M, Bamidele M, Fesobi TW, AbdusSalam A, Nduaga S, Oparaugo CT, Ajayi M, Ogbonna F, Musa AZ, Adedeji A, Ige F, Ihemanma O, Nuhu B, Okebugwu U, Bello IW, Onuigbo TI, Ikemefuna AS, Oraegbu JI, Agboola H, Idris J, Ajayi A, Salako BL, Smith SI. Assessment of potential factors that support the endemicity of cholera in Nigeria from food handlers, health workers and the environment. Microbiol Med 2021. [DOI: 10.4081/mm.2021.10058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background and Aims: Diarrheal diseases caused by bacterial pathogens are widespread and they result in morbidity and mortality of a lot of people yearly. The aim of this study was to assess the role of the environment, health workers and food handlers as reservoirs of Vibrio cholerae, and other diarrhea causing bacteria. Methods: Healthcare workers were proportionally selected and multistage sampling technique was adopted in selecting food handlers for the study. A total of 374 participants consisting of health workers and food handlers were recruited. Socio-demographic and clinical information were collected using questionnaires, while stool and environmental samples were also collected. Results: More female 55.9 % than male 44.1 % participated in the study and the mean age of participants was 38.7 ± 10.9. A significant number of participants identified poor hygiene practices as the major cause of diarrhea. V. cholerae O1 serotype was not detected in any of the environmental samples nor stool samples of both food handlers and health workers. However, V. cholerae (Non O1/Non O139) was isolated from the stool samples of food handlers and health workers in Kano State implying that they could be serving a source of the continuous dissemination of the pathogen. Other bacterial pathogens that are aetiology of diarrhea including Salmonella spp. Escherichia coli, Klebsiella oxytoca, and Enterobacter spp. were also isolated. Conclusion: It is therefore imperative that food handlers and health workers undergo periodic health checks to ensure they are free of pathogens they could easily transmit through food or to patients.
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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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