FACULTY OF PUBLIC HEALTH

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    Nutrition-related knowledge and attitude of practising Nigerian medical doctors to nutrition counselling during the covid-19 pandemic 2020.
    (Association of Resident Doctors (ARD), University College Hospital (UCH), Ibadan, 2021) Folasire, O. F.; Ilori, T. O.; Madaki, A
    Background: Adequate nutrition is needed to enhance the immune system, especially at the time of COVID-19 pandemic for disease prevention and treatment. Objective: The study aimed to assess physicians’ knowledge to nutrition-related issues of COVID-19 infection and explore their attitudes to offering nutritional counselling to patients. Method: This was a cross-sectional online study conducted among doctors in private and public institutions across the six (6) geo-political zones in Nigeria using the social media online platforms of the Nigerian Medical Association (NMA) from August 17 to September 26, 2020. A categorisation of the knowledge score into sufficient and insufficient was done using the mean (sd) knowledge score. The attitude score was categorised into positive and negative using the median (IQR) attitude score, and bivariate analysis was used to test for associations. Results: Responses were gotten from a total of 176 doctors over six weeks of data collection. Majority 97(55.1%) were females, and 84 (47.7%) had practised between 11 and 20 years. Majority 95(54.0%) had insufficient knowledge, while 128(72.7%) of the respondents had a negative attitude to nutrition counselling of patients regarding COVID-19. Females had significantly better knowledge about nutrition related issues of COVID-19 (p=0.004). However, there was no significant difference in the respondents’ attitude based on professional cadre, gender, place of practice, and years of practice. Conclusion: Respondents were deficient in the knowledge of common food items containing relevant nutrients essential for boosting immunity. Hence, there is a need to encourage physicians training in nutrition and nutritional counselling.
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    Food-related coping strategies adopted by some households during covid-19 lockdown in Nigeria
    (Open Journals Nigeria, 2021) Ariyo, O.; Samuel, F. O.; Eyinla, T. E.; Leshi, O. O.; Brai, B. I. C.; Afolabi, W. O.
    As part of the measures to contain the spread of the COVID-19 virus in Nigeria during the early stages of the pandemic, a lockdown of movements within and from outside the country was declared by the federal government. This article presents findings on food-related coping strategies adopted during the COVID-19 lockdown in Nigeria. A cross sectional survey using an online based questionnaire received responses from 883 households regarding information on food consumption, health seeking behaviour and food coping strategies during the COVID-19 lockdown. Food Coping Strategy Index (FCSI) was computed from the data received based on standard methods. Analysis and presentation of data was done using descriptive and inferential statistics. The key findings show that daily mealtimes generally reduced from an average of 3 to 2 times. The storage capacity of households showed an average of 2-week food stock of staples, and most of the respondents had started reducing either their usual portion sizes or frequency of meals in order to cope with food shortages. As regards health seeking behavior, older respondents were more likely to take prophylactic medication (p<0.004) and there was a higher preference for fruits and Vitamin C as prophylactic items. A negative correlation between FCSI with mealtime during COVID-19 lockdown (p<0.000) and monthly income (p<0.000) was observed. The findings presented provide information for policy intervention in the areas of social safety nets and palliatives disbursement in the event of similar lockdown restrictions in the future.
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    Food Access and Experience of Food Insecurity in Nigerian Households during the COVID-19 Lockdown
    (Scientific Research Publishing, 2021) Samuel, F. O.; Eyinla, T. E.; Ariyo, O.; Leshi, O. O.; Brai, B. I. C.; Afolabi, W. A. O.
    The food insecurity experiences and related behaviors of Nigerian households during the COVID-19 lockdown have not been fully discussed. This study was conducted to elicit information on the impact of COVID-19 lockdown on economic and behavioral patterns related to food access. An online-based semi-structured questionnaire distributed through messaging platforms was used to collect information on characteristics, food purchasing behaviour before and during COVID-19 lockdown among respondents. Experience of food insecurity was assessed using Food Insecurity Experience Scale (FIES). A total of 883 responses were received and analyzed using SPSS Version 20.0. Most of the respondents (90.5%) were at home or had stopped going to work due to COVID-19 restrictions. Even though smaller households had higher food expenditure claims than larger households (p = 0.012), the larger the household, the more acute the challenge of economic access to food (p = 0.050). Location (p = 0.000), age (p = 0.003), occupation (p = 0.014) and income level (p = 0.000) were associated with experience of food insecurity. In conclusion, lockdown restrictions increased food expenditure and experience of food insecurity among the respondents and thus we recommend the probe of longterm consequences of deviations from usual food access on undernutrition or overnutrition in Nigerian households.
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    A randomized, open-label trial of combined nitazoxanide and atazanavir/ritonavir for mild to moderate COVID-19
    (Frontiers Media SA, 2022) Fowotade, A.; Bamidele, F.; Egbetola, B.; Fagbamigbe, A. F.; Adeagbo, B. A.; Adefuye, B. O.; Olagunoye, A.; Ojo, T. O.; Adebiyi, A. O.; Olagunju, O. I.; Ladipo, O. T.; Akinloye, A.; Onayade, A.; Bolaji, O. O.; Rannard, S.; Happi, C.; Owen, A.; Olagunju, A.
    Background: The nitazoxanide plus atazanavir/ritonavir for COVID-19 (NACOVID) trial investigated the efficacy and safety of repurposed nitazoxanide combined with atazanavir/ritonavir for COVID-19. Methods: This is a pilot, randomized, open-label multicenter trial conducted in Nigeria. Mild to moderate COVID-19 patients were randomly assigned to receive standard of care (SoC) or SoC plus a 14-day course of nitazoxanide (1,000 mg b.i.d.) and atazanavir/ritonavir (300/100 mg od) and followed through day 28. Study endpoints included time to clinical improvement, SARS-CoV-2 viral load change, and time to complete symptom resolution. Safety and pharmacokinetics were also evaluated (ClinicalTrials.gov ID: NCT04459286). Results: There was no difference in time to clinical improvement between the SoC (n = 26) and SoC plus intervention arms (n = 31; Cox proportional hazards regression analysis adjusted hazard ratio, aHR = 0.898, 95% CI: 0.492–1.638, p = 0.725). No difference was observed in the pattern of saliva SARS-CoV2 viral load changes from days 2–28 in the 35% of patients with detectable virus at baseline (20/57) (aHR = 0.948, 95% CI: 0.341–2.636, p = 0.919). There was no significant difference in time to complete symptom resolution (aHR = 0.535, 95% CI: 0.251–1.140, p = 0.105). Atazanavir/ritonavir increased tizoxanide plasma exposure by 68% and median trough plasma concentration was 1,546 ng/ml (95% CI: 797–2,557), above its putative EC90 in 54% of patients. Tizoxanide was undetectable in saliva. Conclusion: Nitazoxanide co-administered with atazanavir/ritonavir was safe but not better than standard of care in treating COVID-19. These findings should be interpreted in the context of incomplete enrollment (64%) and the limited number of patients with detectable SARS-CoV-2 in saliva at baseline in this trial.
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    Implications of WHO COVID-19 interim guideline 2020.5 on the comprehensive care for infected persons in Africa Before, during and after clinical management of cases
    (Elsevier B.V., 2022) Fagbamigbe, A. F.; Tolba, M. F.; Amankwaa, E. F.; Mante, P. K.; Sylverken, A. A.; Zahouli, J. Z. B.; Goonoo, N.; Mosi, L.; Oyebola, K.; Matoke-Muhia, D.; de Souza, D. K.; Badua, K.; Dukhi, N.
    The novel coronavirus disease 2019 (COVID-19) is one of the biggest public health crises globally. Although Africa did not display the worst-case scenario compared to other continents, fears were still at its peak since Africa was already suffering from a heavy load of other life-threatening infectious diseases such as HIV/AIDS and malaria. Other factors that were anticipated to complicate Africa’s outcomes include the lack of resources for diagnosis and contact tracing along with the low capacity of specialized management facilities per capita. The current review aims at assessing and generating discussions on the realities, and pros and cons of the WHO COVID-19 interim guidance 2020.5 considering the known peculiarities of the African continent. A comprehensive evaluation was done for COVID-19-related data published across PubMed and Google Scholar (date of the last search: August 17, 2020) with emphasis on clinical management and psychosocial aspects. Predefined filters were then applied in data screening as detailed in the methods. Specifically, we interrogated the WHO 2020.5 guideline viz-a-viz health priority and health financing in Africa, COVID-19 case contact tracing and risk assessment, clinical management of COVID-19 cases as well as strategies for tackling stigmatization and psychosocial challenges encountered by COVID-19 survivors. The outcomes of this work provide links between these vital sub-themes which may impact the containment and management of COVID-19 cases in Africa in the long-term. The chief recommendation of the current study is the necessity of prudent filtration of the global findings along with regional modelling of the global care guidelines for acting properly in response to this health threat on the regional level without exposing our populations to further unnecessary adversities.
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    The dynamics of COVID-19 outbreak in Nigeria: A sub-national analysis
    (Elsevier B.V., 2021) Ayodele, K. P.; Jimoh, H.; Fagbamigbe, A. F.; Onakpoya, O. H.
    The African health crisis feared at the beginning of the COVID-19 pandemic has not materialized, and there is interest globally in understanding possible peculiarities in COVID-19 outbreak dynamics in the tropics and sub-tropics that have led to a much milder African outbreak than initial projections. Towards this, Susceptible-Infected-Recovered-Dead compartmental models were fitted to COVID-19 data from all Nigerian states in this study, from which four parameters were estimated per state. A density-based clustering method was used to identify states with similar outbreak dynamics, and the stage of the outbreak determined per state. Subsequently, outbreak dynamics were correlated with absolute humidity, temperature, population density and distance to the international passenger travel gateways in the country. The models revealed that while the outbreak is still increasing nationally, outbreaks in at least 12 states have peaked. A total of at least 519,672 confirmed cases were predicted by January 2021, with a worst case scenario of at least 14,785,457. Weak positive correlations were found between COVID-19 spread and absolute humidity (Pearson’s Coefficient = 0.136, p< 0.05) and temperature (Pearson’s Coefficient = 0.021, p< 0.05). While many studies have established links between temperature and humidity and COVID-19 spread, the correlation has most usually been negative where it exists. The findings in this study of possible positive correlation is in line with a number of previous studies showing such unexpected correlations in the tropics or subtropics. This highlights even more the importance of additional studies on COVID-19 dynamics in Africa.
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    The spread of COVID-19 outbreak in the first 120 days: a comparison between Nigeria and seven other countries
    (BioMed Central, 2021) Adebowale, A. S.; Fagbamigbe, A. F.; Akinyemi, J. O.; Obisesan, O. K.; Awosanya, E. J.; Afolabi, R. F.; Alarape, S. A.; Obabiyi, S. O.
    Background: COVID-19 is an emerging public health emergency of international concern. The trajectory of the global spread is worrisome, particularly in heavily populated countries such as Nigeria. The study objective was to assess and compare the pattern of COVID-19 spread in Nigeria and seven other countries during the first 120 days of the outbreak. Methods: Data was extracted from the World Bank’s website. A descriptive analysis was conducted as well as modelling of COVID-19 spread from day one through day 120 in Nigeria and seven other countries. Model fitting was conducted using linear, quadratic, cubic and exponential regression methods (α=0.05). Results: The COVID-19 spread pattern in Nigeria was similar to the patterns in Egypt, Ghana and Cameroun. The daily death distribution in Nigeria was similar to those of six out of the seven countries considered. There was an increasing trend in the daily COVID-19 confirmed cases in Nigeria. During the lockdown, the growth rate in Nigeria was 5.85 (R2 =0.728, p< 0.001); however, it was 8.42 (R2 =0.625, p< 0.001) after the lockdown was relaxed. The cubic polynomial model (CPM) provided the best fit for predicting COVID-19 cumulative cases across all the countries investigated and there was a clear deviation from the exponential growth model. Using the CPM, the predicted number of cases in Nigeria at 3-month (30 September 2020) was 155,467 (95% CI:151,111-159,824, p< 0.001), all things being equal. Conclusions: Improvement in COVID-19 control measures and strict compliance with the COVID-19 recommended protocols are essential. A contingency plan is needed to provide care for the active cases in case the predicted target is attained.
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    Situation assessment and natural dynamics of COVID-19 pandemic in Nigeria, 31 May 2020
    (Elsevier B.V., 2021) Adebowale, S.; Fagbamigbe, A. F.; Akinyemi, J. O.; Obisesan, K. O.; Awosanya, E. J.; Afolabi, R. F.; Alarape, S. A.; Obabiyi, S. O.
    Background: The coronavirus disease (COVID-19) remains a global public health issue due to its high transmission and case fatality rate. There is apprehension on how to curb the spread and mitigate the socio-economic impacts of the pandemic, but timely and reliable daily confirmed cases’ estimates are pertinent to the pandemic’s containment. This study therefore conducted a situation assessment and applied simple predictive models to explore COVID-19 progression in Nigeria as at 31 May 2020. Methods: Data used for this study were extracted from the websites of the European Centre for Disease Control (World Bank data) and Nigeria Centre for Disease Control. Besides descriptive statistics, four predictive models were fitted to investigate the pandemic natural dynamics. Results: The case fatality rate of COVID-19 was 2.8%. A higher number of confirmed cases of COVID-19 was reported daily after the relaxation of lockdown than before and during lockdown. Of the 36 states in Nigeria, including the Federal Capital Territory, 35 have been affected with COVID-19. Most active cases were in Lagos (n = 4064; 59.2%), followed by Kano (n = 669; 9.2%). The percentage of COVID-19 recovery in Nigeria (29.5%) was lower compared to South Africa (50.3%), but higher compared to Kenya (24.1%). The cubic polynomial model had the best fit. The projected value for COVID-19 cumulative cases for 30 June 2020 in Nigeria was 27,993 (95% C.I: 27,001–28,986). Conclusion: The daily confirmed cases of COVID-19 are increasing in Nigeria. Increasing testing capacity for the disease may further reveal more confirmed cases. As observed in this study, the cubic polynomial model currently offers a better prediction of the future COVID-19 cases in Nigeria.