IntroductionThe COVID-19 pandemic has gravely affected the lives and economies of the global population including Nigeria. The attainment of herd immunity through mass COVID-19 vaccination is the foremost control strategy, however, the deployments of COVID-19 vaccinations are facing challenges of non-acceptance. Despite the efforts of the Nigerian government and COVAX facility in making COVID-19 vaccination more available/accessible, the vaccination rate remains unexpectedly very low in Nigeria/Ebonyi state. Therefore, it is important to investigate the acceptability of COVID-19 vaccination to elucidate the explanations for the very low coverage rate. This study aims to evaluate/explore COVID-19 vaccination acceptance and the determinants among community members and health workers in Ebonyi state, Nigeria.Methods and analysesThe study is an analytical cross-sectional survey with a concurrent-independent mixed method design. Quantitative data will be collected from all consenting/assenting community members aged 15 years and above, in 28 randomly selected geographical clusters, through structured interviewer-administered questionnaire household survey using KoBoCollect installed in android devices. Quantitative data will be collected from all consenting health workers, selected via convenience and snowball techniques, through structured self-administered questionnaire survey distributed via WhatsApp and interviewer-administered survey using KoBoCollect installed in android devices. Qualitative data will be collected from purposively selected community members and health workers through focus group discussions. Quantitative analyses will involve descriptive statistics, generalised estimating equations (for community members data) and generalised linear model (for health workers data). Qualitative analyses will employ the thematic approach.Ethics and disseminationEthical approval for this study was obtained from the Ebonyi State Health Research and Ethics Committee (EBSHREC/15/01/2022–02/01/2023) and Research and Ethics Committee of Alex Ekwueme Federal University Teaching Hospital Abakaliki (14/12/2021–17/02/2022), and verbal consent will be obtained from participants. Study findings will be reported at local, national and international levels as appropriate.Trial registration numberISRCTN16735844.

ObjectivesHealth workers are at particular risk of contracting the COVID-19. However, non-acceptance of COVID-19 vaccination has been a noticeable challenge the world over and in Nigeria where supply constraints have also been an issue. We evaluated COVID-19 vaccination acceptance (the uptake, hesitancy, intention to receive and timeliness of the intention to receive) and the determinants, and the predictive power of acceptance factor compared with availability/access factor, among health workers in Ebonyi state.MethodsWe conducted an online-offline survey, between 12 March 2022 and 9 May 2022, among all consenting health workers (clinical/non-clinical, public/private) working/living in Ebonyi state and who were selected by convenience and snowballing techniques. Data were collected using structured self-administered questionnaire distributed via WhatsApp and interviewer-administered questionnaire in KoBoCollect installed in android devices. Data were analysed using descriptive statistics and generalised linear models.Results1276 health workers were surveyed. Uptake was 68.2% vaccinated, 47.4% fully vaccinated and 20.9% partially vaccinated. Hesitancy was 22.6% or 71.2% among the unvaccinated (76.3% of hesitancy due to refusal and 23.7% to delay). Intention to receive was 36.0% of which 55.1% gave the intended time (days) to receive with a median (IQR) of 30 days (7–133). The strongest and most important predictor of COVID-19 vaccination acceptance was COVID-19 vaccination expectations and perceptions. Other important predictors were COVID-19/COVID-19 vaccination process experiences and perceptions. Acceptance factor was a stronger predictor compared with availability/access factor.ConclusionThe slow pace of COVID-19 vaccination coverage among the health workers in Ebonyi state/Nigeria may encounter a bottle-neck due to the high refusal rate among the unvaccinated. COVID-19 vaccination policy interventions in Nigeria and other similar settings should, in addition to sustaining availability and access, prioritise improvement of COVID-19 vaccination expectations and perceptions (regarding importance/safety/effectiveness) and COVID-19 risk communication among the health workers.Trial registration numberISRCTN16735844.

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Introduction: The outbreak of coronavirus disease 2019 (COVID-19) in Nigeria prompted decision-making at the various levels of governance. Ebonyi State Government in South-east Nigeria closed her borders with neighboring states as a preventive measure for the spread of the pandemic. This study was an assessment of the effectiveness and challenges of border closure and surveillance activities in controlling the dispersion of the disease across states. Materials and Methods: The five major borders of Ebonyi State with her neighboring States of Enugu, Cross River, and Abia were visited. Information was collected about movement restrictions and surveillance at the borders using an observation checklist and key informant interviews. Data collected were analyzed using IBM-SPSS and thematic interpretation. Results: Commuters on essential duty were enforced to wear face masks, perform hand hygiene, and undergo screening for the symptoms of COVID-19 before entering the State. All the first 13 COVID-19 confirmed persons in the State were from those picked up as suspected cases by surveillance at the State borders. People who travelled hundreds of kilometers across several States were stopped from entering Ebonyi State. However, movement restriction at the borders was undermined by some security personnel who were bribed by commuters to allow them crossover during night hours. Conclusion: The lockdown and surveillance activities at the borders were effective in controlling the spread of COVID-19, but alternative routes of entry and corrupt act during odd hours constituted serious risks. Uniformity of movement restriction across all the states borders with vigilante groups manning inter-community boundaries may control the disease spread across regions.

Introduction identifying risk factors for SARS-CoV-2 infection and disease severity is critical to developing measures to protect vulnerable groups. We aimed to identify risk factors for SARS-CoV-2 infection and severe disease. Methods this was an unmatched case-control study that recruited participants in the country from April to July 2020. Cases tested positive on Reverse-Transcription Polymerase Chain Reaction (RT-PCR), while controls tested negative on RT-PCR. Data were collected by trained research assistants using an interviewer-administered questionnaire. Cases were categorized into severe and non-severe to identify risk factors for severe disease. Results there were 497 cases and 997 controls recruited. Contact with a symptomatic confirmed case adjusted odds ratio (aOR) 1.91 (95% CI: 1.30-2.80) and attendance of mass gatherings aOR 1.74 (95% CI: 1.10-2.74) were associated with SARS-CoV-2 infection, while the use of private transportation aOR 0.56 (95% CI: 0.37-0.85) and use of a face mask aOR 0.43 (95% CI: 0.19-0.95) were associated with lower odds of infection. We identified 38 (7.7%) severe cases and 459 (92.3%) non-severe cases. Multivariate analysis identified age ≥ 50 years aOR 4.54 (95% CI: 1.86-11.08), male sex aOR 2.95 (95% CI: 1.07-8.11), hypertension aOR 3.52 (95% CI: 1.46-8.50), and diabetes aOR 5.76 (95% CI: 2.01-16.50) as risk factors for severe disease, while Hausa ethnicity aOR 0.15 (95% CI: 0.04-0.62) lowered the odds of severe disease. Conclusion our findings highlight the importance of exposure history, mass gatherings, private transportation, and the use of face masks. Being over 50 years, male and having comorbidities indicate a worse prognosis.