Mpox in Nigeria: Perceptions and knowledge of the disease among critical stakeholders-Global public health consequences

BACKGROUND

The mpox (monkeypox) disease is a re-emerging viral zoonosis of international concern that is endemic in parts of Africa. The mpox virus (MPXV), which was hitherto largely limited to some Central and West African countries, was declared a public health emergency of international concern by the WHO on July 23, 2022 following the rapid spread of the virus to non-endemic countries. Globally, as of March 16, 2023, the WHO had reported 86,496 laboratory-confirmed cases of mpox and 111 deaths in 110 countries. Of the 1,420 cases of mpox reported in Africa as of March 16, 2023, Nigeria alone recorded 57.1% (812) of the confirmed cases and eight fatalities recorded in the continent. To help improve on the understanding of the current situation in Nigeria, the present study assessed the perception and knowledge of mpox among Nigerian healthcare workers, academics and tertiary students. The study also sought to highlight the global public health significance of the MPXV, and recommend a One Health approach to limit exporting of the virus beyond the borders of Nigeria.

METHODS

A web-based cross-sectional survey was conducted between 24 July 2022 and 12 August 2022 to evaluate the perception and knowledge of mpox among 1544 Nigerians, consisted of healthcare workers (n = 832), academics (n = 306) and tertiary students (n = 462). Data on the respondents' socio demographics and their information sources on mpox were also collected. Each correct response was allotted one point while an incorrect response was scored zero. The scores for perception and knowledge were dichotomized into positive (>5.5) and negative (≤5.5) and adequate (>5.8) and inadequate (≤5.8), respectively; using the average scores for perception and knowledge. The average score for perception and knowledge were summarised and presented as the mean and standard deviation (SD). Chi-square tests of association and binary logistic regression were carried out to determine factors associated with the outcome variables.

RESULTS

Of the 1452 respondents that had heard of mpox, 878 (60.5%) and 419 (28.9%) had adequate knowledge and positive perception concerning MPXV infection respectively. Average perception score was 5.5. Mean perception and knowledge scores were 4.5(SD: 2.0) and 5.8 (SD: 1.9), respectively. Factors that were significantly associated with knowledge level were age (p = 0.020) educational qualification attained (p = 0.004), occupation (p<0.001), and geopolitical zone of residency (p = 0.001). There was a positive correlation between perception and knowledge scores (r = 0.4, p<0.001). Positive perceptions were likely among respondents who had tertiary education, and residing in North-west Nigeria. Likewise, adequate knowledge scores were likely among respondents under 30 years of age, with tertiary education or reside in North-west Nigeria. Sources of information were significantly associated with perception (p = 0.004) and knowledge (p<0.001) of the respondents.

CONCLUSION

The findings of this study show that there is disparity in the knowledge and perception of mpox in the study population, and as a result, there is a need to intensify awareness about MPXV infection to enhance positive perception among the respondents. This has potential to safeguard public health and contain the disease thus preventing it from spreading to the global community. A One Health approach involving animal and human health workers is imperative for improved knowledge and a good perception towards the disease among respondents, and enhanced active surveillance and early detection of MPXV in reservoir hosts (rodents and non-human primates); to prevent reverse zoonotic transmission of the virus at the human-animal interface.

Persisting Vaccine Hesitancy in Africa: The Whys, Global Public Health Consequences and Ways-Out-COVID-19 Vaccination Acceptance Rates as Case-in-Point

Vaccine hesitancy (VH) is the seventh among the WHO's top 10 threats to global public health, which has continued to perpetuate the transmission of vaccine preventable diseases (VPDs) in Africa. Consequently, this paper systematically reviewed COVID-19 vaccine acceptance rates (VARs)-including the vaccine uptake and vaccination intention-in Africa from 2020 to 2022, compared the rates within the five African regions and determined the context-specific causes of VH in Africa. Generally, COVID-19 VARs ranged from 21.0% to 97.9% and 8.2% to 92.0% with mean rates of 59.8 ± 3.8% and 58.0 ± 2.4% in 2021 and 2022, respectively. Southern and eastern African regions had the top two VARs of 83.5 ± 6.3% and 68.9 ± 6.6% in 2021, and 64.2 ± 4.6% and 61.2 ± 5.1% in 2022, respectively. Based on population types, healthcare workers had a marginal increase in their mean COVID-19 VARs from 55.5 ± 5.6% in 2021 to 60.8 ± 5.3% in 2022. In other populations, the mean VARs decreased from 62.7 ± 5.2% in 2021 to 54.5 ± 4% in 2022. As of 25 October 2022, Africa lags behind the world with only 24% full COVID-19 vaccinations compared to 84%, 79% and 63% reported, respectively, in the Australian continent, upper-middle-income countries and globally. Apart from the problems of confidence, complacency, convenience, communications and context, the context-specific factors driving COVID-19 VH in Africa are global COVID-19 vaccine inequality, lack of vaccine production/maintenance facilities, insecurity, high illiteracy level, endemic corruption, mistrust in some political leaders, the spreading of unconfirmed anti-vaccination rumors and political instability. With an overall mean COVID-19 acceptance rate of 58%, VH still subsists in Africa. The low VARs in Africa have detrimental global public health implications, as it could facilitate the emergence of immune invading SARS-CoV-2 variants of concern, which may spread globally. Consequently, there is a need to confront these challenges frontally and engage traditional and religious leaders in the fight against VH in Africa, to restore public trust in the safety and efficacy of vaccines generally. As the availability of COVID-19 vaccines improves, the vaccination of pets and zoo-animals from which reverse zoonotic transmission of SARS-CoV-2 have been reported is recommended, to limit the evolution and spread of new variants of concern and avert possible SARS-CoV-2 epizootic or panzootic diseases in susceptible animal species.

COVID-19 Vaccine Hesitancy and Determinants of Acceptance among Healthcare Workers, Academics and Tertiary Students in Nigeria

The COVID-19 pandemic has resulted in millions of human deaths, prompting the rapid development and regulatory approval of several vaccines. Although Nigeria implemented a COVID-19 vaccination program on 15 March 2021, low vaccine acceptance remains a major challenge. To provide insight on factors associated with COVID-19 vaccine hesitancy (VH), we conducted a national survey among healthcare workers, academics, and tertiary students, between 1 September 2021 and 31 December 2021. We fitted a logistic regression model to the data and examined factors associated with VH to support targeted health awareness campaigns to address public concerns and improve vaccination rates on par with global efforts. A total of 1525 respondents took part in the survey, composed of healthcare-workers (24.5%, 373/1525), academics (26.9%, 410/1525), and students (48.7%, 742/1525). Only 29% (446/1525) of the respondents were vaccinated at the time of this study. Of the 446 vaccinated respondents, 35.7% (159/446), 61.4% (274/446) and 2.9% (13/446) had one, two and three or more doses, respectively. Reasons for VH included: difficulty in the vaccination request/registration protocols (21.3%, 633/1079); bad feelings towards the vaccines due to negative social media reports/rumours (21.3%, 633/1079); personal ideology/religious beliefs against vaccination (16.7%, 495/1079); and poor confidence that preventive measures were enough to protect against COVID-19 (11%, 323/1079). Some health concerns that deterred unvaccinated respondents were: innate immunity issues (27.7%, 345/1079); allergic reaction concerns (24.6%, 307/1079); and blood clot problems in women (21.4%, 266/1079). In the multivariable model, location of respondents/geopolitical zones, level of education, testing for COVID-19, occupation/job description and religion were significantly associated with VH. Findings from this study underscore the need for targeted awareness creation to increase COVID-19 vaccination coverage in Nigeria and elsewhere. Besides professionals, similar studies are recommended in the general population to develop appropriate public health interventions to improve COVID-19 vaccine uptake.

Determinants of Work-Related Risks among Veterinary Clinical Students in South West Nigeria

Veterinary practices or activities expose professionals, including students, to hazards associated with animal contact. To describe workplace health and safety status and risk factors associated with hazards among veterinary clinical students in South West Nigeria, a cross-sectional survey was conducted using a semistructured questionnaire. Data on demographics, health and safety (HS) status, work-related hazards, healthcare facilities, and immunisation history were obtained. Of 167 students recruited, 100 (60.2%) were males, and >77.1% fell within the age group of 21-25 years. Many participants (77.0%) reported the lack of active HS committee. Exposures to various physical hazards (PHs) such as needlestick injuries (NSIs, 41.5%), animal scratches (42.0%), animal kicks (33.0%), falls/slips (25.0%), and, less frequently, animal bites (13.8%) were reported. Allergies (35.9%) and acute gastrointestinal infection (25.6%) mainly after contact with dogs presented with parvoviral enteritis were reported. For chemical hazards, 27.8% and 29.0% of participants indicated having had eye burn and choke on exposure to formalin. No adequate immunisation against either tetanus, rabies, or both was provided (<18%). An association between accommodation type and students' level of health and safety training was observed (OR = 0.46, 95% CI: 0.241-0.897, p=0.02), and frequencies of student contact with various animal types were strongly associated with exposures to different physical and biological risks (p < 0.05). This study revealed poor health and safety training, practices, and increased exposure of students to a wide range of hazards. Therefore, the development of mitigation programmes in veterinary schools becomes critical to safeguard students' wellbeing.

Prevalence and renal pathology of pathogenic Leptospira spp. in wildlife in Abeokuta, Ogun State, Nigeria

There is paucity of information on the prevalence of leptospirosis in wildlife in Nigeria. This study investigated the prevalence and renal pathology of leptospirosis in wild animals in Southwest Nigeria. One hundred and five kidney samples were examined from 10 different wildlife species (antelope) greater cane rat (GCR), hare, African giant rat (AGR), tree hyrax, civet cat, monitor lizard, python, bushbuck and partridge) using a combination of Ellinghausen McCullough Johnson Harris (EMJH) medium, microscopic agglutination test (MAT), Warthin- Starry silver stain (WSss) and immunohistochemistry. Chi-square test was used with confidence level set at 0.05 to ascertain associations between positive cases and sex and species. Eightytwo (78.1%) samples were culturally positive, while 67.7% (63/93), 57.0% (16/28) and 66.7% (8/12) were WSss, MAT and immunohistochemically positive, respectively. Interstitial nephritis (41.0%) and tubular nephrosis (81.0%) were the most prominent histopathological changes. Pathogenic Leptospira organisms were highest in GCR (32.1%) and antelope (14.3%). Serovars hardjo (11.54%), bratislava (3.9%), canicola (3.9%), icterohaemorrhagiae (15.4%), pomona (7.14%) gripptotyphosa (19.2%) and undetermined isolates were also detected in other animals. The result showed high prevalence of Leptospira infection in the wild and the possibility of domestic animals and humans contracting the disease. This study is the first documentation of evidence of pathogenic Leptospira species in wildlife in Nigeria.