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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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Recife is one of many regions in the North Eastern section of Brazil to be hit hard by the Zika virus outbreak in 2015. Zika infection is caused by the arboviruses transmitted by the Aedes mosquitoes which are abundant in Brazil. It is a known fact that increased abundance of the Aedes mosquito is typically associated with standing (or stagnant) water which serves as a reservoir or hotspot for breeding. Apart from the presence of standing (or stagnated) water in human dwellings, it is important to consider other intermediate factors that drive the mosquitoes to increase in population size. We consider the example of a set of climate conditions such as land surface temperature, humidity, precipitation, seasonality etc. These are typical risk factors that must be taken into consideration especially for the spatial and early warning prediction of breeding hotspots for the Aedes mosquito species responsible for transmitting Zika viruses in Brazil. In this work-in-progress study, we bring together historical records from a mosquito surveillance and control programme conducted by the Centre for Environmental Surveillance Agency in Recife and open source climate information. We use a population-based ecological study design to explore the regional-level spatialtemporal relationship between the prevalence of households detected to have increased mosquito larvae density and environmental risk factors such as temperature and precipitation.

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