BackgroundEmergence of the COVID-19 pandemic created unexpected challenges for health care workers. The global and national supply chain system was disrupted, and affected infection, prevention and control practices. This study aimed at documenting health workers knowledge, attitudes and practices (KAP) on IPC in Nigeria during the COVID-19 pandemic. MethodsThe descriptive, mixed-methods cross-sectional study was conducted in Ebonyi, Ondo and Niger states in October 2020. A structured questionnaire that asked healthcare providers about their current knowledge, attitudes and practices and changes among them following the start of the pandemic was complemented by semi-structured interviews that were audio recorded, transcribed and analysed in Atlas.ti. Quantitative data were entered into REDCap and cleaned, transformed and analysed using descriptive statistics in SPSS version 25.0 Findings from the qualitative interviews were used to explain the trends observed from quantitative study.ResultsThere were demographic differences between community and facility-based health workers in our population. CHIPS that agreed to have not attended IPC training were 54.9% and 71.4% for HCWs, compared to those that attended IPC training during COVID-19 pandemic (CHIPS – 62.8%, HCWs – 53.4%). Health care workers had good knowledge of general IPC, attitude and practice of IPC during COVID-19 pandemic. However, the knowledge of the relative effectiveness of prevention measures was low. The mean knowledge scores were greater among facility-based workers compared to community based healthcare workers (p= 0.001). Self-reported IPC practices increased during the pandemic compared to prior to the pandemic, with the exception of the use of N-95 masks and hand sanitizer.ConclusionThis study found good general IPC knowledge and practices in our study population. There is need for continued support for correct hand hygiene, and to reinforce the relative importance of different IPC practices to ensure adherence to COVID-19 preventive measures. The study recommends sustained training and supply of PPEs and other materials needed for IPC reminds policy makers that budget line specific to COVID-19 response across all the levels of health

Background: The World Health Organization recommends a minimum of three doses of quality-assured sulfadoxine-pyrimethamine for intermittent preventive treatment of malaria during pregnancy (IPTp), in moderate to high malaria transmission areas in sub-Saharan Africa. This treatment prevents malaria in pregnancy contributing to reduced maternal and infant morbidity and mortality. Currently, coverage of IPTp lags behind coverage of antenatal care (ANC) visits; in Nigeria, 57% of women attended four or more ANC visits, whereas only 17% received the recommended three or more doses of IPTp. The innovative program aimed to close this gap by providing counseling on the benefits of comprehensive ANC, referral to ANC and community distribution of IPTp (C-IPTp), complementing IPTp at ANC. Methods: The data for this study were extracted from the maternity record books for pregnant women at 25 public health facilities in Ebonyi State, Nigeria. The outcome of interest was defined as the receipt of three or more doses of IPTp (IPTp3) and the primary covariate was referral to ANC by a community health worker for any visit. Descriptive statistics were reported and the results from the multi-level regressions are reported as adjusted odds and prevalence ratios with corresponding 95% confidence intervals. Results: Of the 936 women included in the analysis, 24.47% received the recommended three or more IPTp doses and 61.32% were referred by a community health worker (CHW) for at least one ANC visit. There was no difference in the average number of ANC visits between women who received C-IPTp and those who received IPTp exclusively at a facility. There were no maternal characteristics associated with CHW referral. Women who were referred by a CHW had 60% greater odds (95% CI: 1.08-2.38) of receiving IPTp3 than those who were never referred. Conclusion: The results indicate that CHW referrals conducted within a C-IPTp program increase IPTp uptake without disrupting ANC attendance and that CHWs applied the referral process equally. This strengthens the evidence base for C-IPTp scale-up, which could have a large impact in sub-Saharan Africa in mitigating existing health systems issues.

BackgroundCOVID-19 disrupted health service delivery and weakened global and national health systems. The objective of this study was to describe the changes in health service utilization in three local government areas in three Nigerian states and examine factors involved.MethodsA cross-sectional mixed-methods approach was used to examine changes in service utilization during the first nine months of the COVID-19 pandemic and associated factors in three Nigerian states; Ebonyi, Niger and Ondo. A total of 315 pregnant women seen for antenatal care in 80 health facilities between October 1 and November 30, 2020, participated in exit interviews; 93 women participated in focus group discussions (FGDs). Descriptive analyses and a multivariable logistic analysis were conducted to examine associations between characteristics and decreased service utilization. Content analysis was used to identify the emerging themes for factors that impacted health service utilization during the pandemic.ResultsOne quarter of women surveyed reported that they reduced or ceased health service utilization during this initial period of the pandemic. The biggest reported changes in visits were for immunization (47% pre-pandemic versus 30% during the pandemic, p<0.001) and a small but statistically significant decline in antenatal care (99% to 94%, p<0.001) was observed.State of residence was significantly associated with reduced or ceased utilization during the pandemic (p<0.01); other sociodemographic characteristics were not. Qualitative findings show that lockdowns, transportation issues, increased costs and fear of contracting COVID-19 or being labeled as COVID-positive were the most common reasons mentioned for not seeking care during this period of the pandemic. Conclusions The pandemic from March to November 2020 negatively impacted health service utilization amongst pregnant women in Nigeria. A better understanding of differences in the pandemic and state response could help inform future actions. The FGDs findings highlight the need for health systems to consider how to facilitate service utilization during a pandemic, such as providing safe transport or increasing outreach, and to minimize stigma for those seeking care.