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.

Background The rate of diagnostic testing for malaria is still very low in Nigeria despite the scale-up of malaria rapid diagnostic test (MRDT) availability, following WHO's recommendation of universal diagnostic testing in 2010. We investigated whether a social group sensitisation and education intervention (social group intervention) and a social group intervention plus health-care provider training intervention would increase the demand (use or request, or both) for MRDTs among community members in Ebonyi state, Nigeria. MethodsWe did a three-arm, parallel, open-label, stratified cluster-randomised controlled trial in Ebonyi state, Nigeria, to evaluate the effects of two interventions compared with a control. We randomly assigned geographical clusters that were accessible (close to a road that was drivable even during the rainy seasons) and had at least one eligible public primary health facility and patent medicine vendor (those that offered MRDT services) in a 1:1:1 allocation to the control arm (receiving no intervention), social group arm (receiving sensitisation and education about MRDT), or social group plus provider arm (receiving the social group intervention plus provider training in health communication about MRDT). Investigators, participants (social groups, providers, respondents), and interviewers could not be masked to group assignments. The primary outcome was the proportion of children younger than 5 years with fever or malaria-like illness, in the 2 weeks preceding a household survey, who received an MRDT, and the coprimary outcome was the same outcome but among children aged 5 years and older (ie, up to and including 17 years) and adults (excluding pregnant women). The outcomes were measured at an individual level via household surveys before the interventions and 3 months after the end of the interventions. All analyses were done using a cluster-level method on an intention-to-treat basis. This trial is registered with ISRCTN, number ISRCTN14046444. FindingsWe carried out eligibility screening and recruitment of participants (clusters, social groups, and providers) between July 2 and Sept 27, 2018. 34 clusters met the eligibility criteria and 18 were randomly selected to participate and randomly assigned to arms (six clusters per arm). A mean proportion of 40•6% (SD 14•5) of eligible children younger than 5 years in the control arm received an MRDT, versus 66•7% (11•7) in the social group arm (adjusted risk difference [aRD] 28•8%, 95% CI 21•9-35•7, p<0•0001) and 71•7% (19•8) in the social group plus provider arm (aRD 32•7%, 24•9-40•5, p<0•0001), with no significant difference between the social group arm and the social group plus provider arm. A mean proportion of 36•3% (18•5) of eligible children aged 5 years and older in the control arm received an MRDT, versus 60•7% (14•0) in the social group arm (aRD 25•6%, 16•8-34•4, p=0•0004), and 59•5% (18•3) in the social group plus provider arm (aRD 28•0%, 19•5-36•5, p=0•0002), with no significant difference between the social group arm and the soci...

Background A good understanding of the demand for malaria rapid diagnostic test (MRDT), malaria health care-seeking behavior, and drug use among community members is crucial to malaria control efforts. The aim of this study was to assess the demand (use and/or request) for MRDT, health care-seeking behavior, and drug use, as well as associated factors, among rural community members (both children and adults) with fever or malaria-like illness in Ebonyi state, Nigeria. Methods A cross-sectional household survey was conducted between October 1st and November 7th, 2018, in 18 rural geographical clusters. Data was collected using a structured interviewer-administered questionnaire. Descriptive analysis was done using summary statistics. Associated factors (socio-demographic, knowledge and opinion level) were assessed using bivariate and multivariate binomial logistic regressions while the overall effects of these factors were assessed using the “postestimation test” command in Stata. Results A total of 1310 children under 5 years of age and 2329 children ages 5 years and above and adults (excluding pregnant women) (3639 overall) participated in the study. Among the 1310 children under 5 years of age: 521 (39.8%) received MRDT of which the caregivers of 82 (15.7%) requested for the MRDT; 931 (71.1%) sought care with public/private sector providers (excluding traditional practitioners/drug hawkers) the same/next day; 495 (37.8%) sought care at government primary health centres, 744 (56.8%) sought care with the patent medicine vendors (PMVs); 136 (10.4%) sought care with traditional practitioners; 1020 (77.9%) took ACTs (=88.2%, 1020/1156 of those who took anti-malarial drugs). Generally, lower values were respectively recorded among the 2329 children ages 5 years and above and adults (excluding pregnant women). The most important overarching predictor of the demand for MRDT and care-seeking behaviour was the knowledge and opinion level of respondent female heads of households about malaria and malaria diagnosis. Conclusions Among the rural community members with fever or malaria-like illness in Ebonyi state, Nigeria, while majority did not receive MRDT or diagnostic testing, and sought care with the PMVs, most took anti-malaria drugs, and mostly ACTs. Interventions are needed to improve the knowledge and opinion of the female heads of households about malaria and malaria diagnosis.

Background The Guidelines for Diagnosis and Treatment of Malaria are meant to guide medical practitioners to enhance optimal management of patients suspected of having malaria which is vital to malarial control and elimination. Medical doctors have the main responsibility for treating patients with malaria so there was need to evaluate the extent to which the medical doctors in Ebonyi state, Nigeria, knew, viewed, and practiced the 2015 National Guidelines for Diagnosis and Treatment of Malaria. Methods A cross-sectional survey was carried out in May, 2019 among medical doctors who were involved in the management of malaria patients and selected via convenience sampling. Data was collected using a structured self-administered questionnaire. Each respondent was categorized as having poor, fair, or good knowledge, attitude, and practice respectively based on knowledge, attitude, and practice scores of <50%, 50–75%, and >75%. Associated factors were evaluated through bivariate and multivariate binomial logistic regressions at 5% probability of type one error and the overall test for the effect of each independent factor on practice level was done using the “postestimation test” command in Stata. Results A total of 156 medical doctors were surveyed. Most, 138 (88.5%) were aware there was a national guideline for diagnosis and treatment of malaria. Among the medical doctors, 19 (12.2%) had good knowledge, 110 (70.5%) had fair knowledge, and 27 (17.3%) had poor knowledge; 38 (24.4%) had good attitude, 74 (47.4%) had fair attitude, and 44 (28.2%) had poor attitude; and 59 (37.8%) had good practice, 90 (57.7%) had fair practice, and 7 (4.5%) had poor practice. The attitude level of the medical doctors toward the 2015 National Guidelines for Diagnosis and Treatment of Malaria was a predictor of good practice (adjusted p-value of overall effect = 0.0003). Conclusions Although most of the medical doctors in Ebonyi state, Nigeria, were aware of the existence of a national guideline, only just over a third of them had good practice of the 2015 National Guidelines for Diagnosis and Treatment of Malaria. Policy interventions should focus on improving the attitude of the medical doctors toward the National Guidelines through training and re-training.

Background: The World Health Organization in 2010 recommended universal testing for suspected malaria cases due to some fundamental changes in malaria trend such as the declining malaria incidence in high burden countries, the emergence of parasite resistance to anti-malarial drugs especially artemisinin-based combination therapies (ACTs) and the increased availability of diagnostic testing such as malaria rapid diagnostic test (MRDT). The Nigerian government has long adopted this recommendation and has scaled up the availability of MRDT with the support of foreign partners. However, the malaria/MRDT test rate in the communities is still far short of the recommendation. This study aims to evaluate the effectiveness of social group and social group/provider interventions in increasing the demand (use and/or request) for MRDT among community members with fever or malaria-like illness in Ebonyi state, Nigeria. Methods: A three-arm, parallel, stratified cluster randomized design will be used to evaluate the effect of two interventions compared to control: control involves the usual practice of provision of MRDT services by public primary health care providers and patent medicine vendors; social group intervention involves the sensitization/education of social groups about MRDT; social group/provider intervention involves social group treatment plus the training of health care providers in health communication with clients about MRDT. The primary outcome is the proportion of under-5 children with fever/malaria-like illness in the preceding two weeks to a household survey that received MRDT. The co-primary outcome is the proportion of 5 years and above children and adults (excluding pregnant women) with fever/malaria-like illness in the preceding two weeks to a household survey that received MRDT. The primary outcome will be assessed through household surveys at baseline and end-line. Discussion: The pragmatic and behavioural nature of the interventions which are delivered to groupings of individuals and the need to minimize contamination informed the use of a cluster randomized design by this study in investigating whether the social group and social group/provider interventions will increase the demand for MRDT among community members. “Pragmatic” means the interventions would occur in natural settings or real live situations.