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    Knowledge of, risk perception towards and reported preventive practices against Lassa fever among health workers in Ondo State, Nigeria

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    Background: Secondary transmission of Lassa fever has been recorded annually among healthcare workers who provided care. An outbreak of the disease in Ondo State, Southwest Nigeria in 2018, recorded high morbidity and mortality. This study was conducted to assess the knowledge, risk perception, and preventive practices towards Lassa fever among healthcare workers.    Methods: A health facility-based descriptive cross-sectional study design was conducted involving senior members of staff randomly selected from the list of staff members. A structured pre-tested questionnaire was administered to 554 consenting respondents in 304 health facilities. Results: More than half of the respondents (317, 57.2%) are health workers in primary healthcare cadres. Although 444 (80.1%) knew the case definition for reporting, only 379 (68.4%) correctly indicated the reporting channel. Concerning risk perception, 174 (31.4%) rated their risk of contracting the disease in the workplace as high, and 309 (55.8%) indicated that hospitals\u27 infection control policy is inadequate. Furthermore, only 76 (13.7%) of the respondents reported having modified their working habits for fear of being infected with Lassa fever three months before the study with 368 (66.4%) and 474 (85.6%) reported that they always use aprons and gloves respectively during treatment of patients. Conclusion: There is a need to strengthen the hospital infection control policy and train healthcare workers on reporting suspected cases

    A juxtaposition of safety outcomes between various doses of sodium-glucose co-transporter inhibitors, in insulin-treated type-1 diabetes mellitus patients: a protocol for systematic review and meta-analysis of randomized controlled trials

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      Background: Several clinical trials have tested the safety profile of sodium-glucose co-transport inhibitors’ (SGLTis) in adult type 1 diabetes mellitus (T1DM) patients. However, no systematic review has yet compared its variation between large and low dose SGLTis. Henceforth, a review protocol is proposed here to review it. Methods: Different electronic databases will be searched for randomized-controlled trials (published in the English language) studying the above objective, irrespective of their publication date. After selecting the eligible trials, their data on the study design, population characteristics, compared interventions, and outcomes of interest will be extracted. Then, utilizing the Cochrane tool, each trial\u27s risk of selection bias, detection bias, performance bias, attrition bias, reporting bias, and other bias will be judged. Next, depending on clinical heterogeneity among the trials, a random-effect or fixed-effect model meta-analysis will be used to compare the respective outcomes. Via the Chi2 and I2 statistics, the statistical inconsistency among the trials will be estimated. When this is substantial, subgroup analysis will follow. Publication bias will be evaluated by funnel plots and Egger’s test. A sensitivity analysis will be done to check different assumptions. If a quantitative juxtaposition is not possible, a narrative reporting will ensue. Conclusion: The proposed study will perform a dose-wise juxtaposition of the safety profile of SGLTis in insulin-treated T1DM patients. Registration: Prospective Register of Systematic Reviews (PROSPERO) (Registration no. CRD42019146578)   &nbsp

    Knowledge, attitude, and practice towards COVID-19 among Syrian people resident in Turkey

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    Background: Measuring knowledge, attitude, and practice towards COVID-19 helps policymakers observe knowledge gaps and provide key messages to people to act better against the pandemic. This study aims to assess the knowledge, attitude, and practice towards COVID-19 among Syrian people resident in Turkey.  Methods: A cross-sectional study designed to assess the knowledge, attitude, and practice towards COVID-19 among the Syrian people resident in Turkey. The data were collected via a web-based and self-administered questionnaire of 313 participants from 17-31 July 2020. SPSS version 16.0 was recruited to analyze the data using univariate and multivariable regression data analyses. Results: Our finding as the first study among Syrian people resident in Turkey found a high rate of good knowledge, attitude, and practice towards COVID-19 accordingly with 83.0%, 72.0%, 84.0%. Regression analysis showed that age-group of 45 years and more years, marital status of being married, female gender, living in urban area were significantly associated with upper knowledge score. Age-group of 45 years and more significantly associated with positive attitude score but inversely being married and unemployed statues significantly associated with a negative attitude. Regarding practice score, married and female people had better practice, but poor-rated health status was significantly associated with the weak practice. Conclusion: Although our finding showed a good rate for knowledge, attitude, and practice towards COVID-19, but it needs to improve cause of many barriers on Syrian people resident in Turkey, such as living in a crowded place, distant from health care services, losing whole or part of their income due to COVID-19 as an economic crisis, different language barriers. Some groups like men, people living in a rural area, and those unemployed or lost their job should be exposed by timely and accurate knowledge

    Infection prevention and control (IPC) at a Lassa fever treatment center before and after the implementation of an intensive IPC program

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    Background: Infection prevention and control (IPC) programs are important to control the Lassa Fever (LF) outbreak. We reported IPC\u27s status at the Federal Medical Centre, Owo, southwest Nigeria, before and after implementing the IPC program during a surge in the LF outbreak. Methods: We conducted a longitudinal observational study among five health care professionals at the Federal Medical Centre, Owo, between February 2019 and May 2019 using the IPC Assessment Framework (IPCAF). The tool has eight core components with a score of 0-100 per component and provided a baseline assessment of the IPC program and evaluation after three months. We interviewed relevant unit heads and IPC committee members in the first phase. In the second phase, we designed and implemented the IPC program, and in the third phase, we conducted a repeat interview similar to the first phase. The program initiated included training healthcare workers and providing relevant IPC items according to identified gaps and available funding. Results: We interviewed five health care professionals, two female nurses, and three male doctors responsible for organizing and implementing IPC activities at the Federal Medical Centre, Owo, with an in-depth understanding of IPC activities.  The overall IPC level score increased from 318.5 at baseline to 545 at three months later. IPC improvements were reported in all the components, with IPC education and training [baseline (20), final (70)], IPC guidelines [baseline (50), final (92.5)] and monitoring/audits of IPC practices and feedback [baseline (40), final (82.5)] recording the highest improvements. Healthcare-associated infection [baseline (10), final (25)], and built environment, materials, and equipment for IPC [baseline (43.5), final (55)] had the least improvement. Poor motivation to adopt recommended changes among hospital staff were major issues preventing improvements. Conclusion: Promotion of IPC program and activities should be implemented at the Federal Medical Centre, Owo.   References World Health Organization, WHO. Lassa fever. Available from: https://www.who.int/health-topics/lassa-fever/#tab=tab_1. [Accessed on 11 October 2020] Nigeria Centre for Disease Control. Lassa fever. Available from: https://ncdc.gov.ng/diseases/factsheet/47. [Accessed on 11 October 2020]. World Health Organization, WHO. Lassa fever. Available from: https://www.who.int/news-room/fact-sheets/detail/lassa-fever. [Accessed on 11 October 2020]. Ijarotimi IT, Ilesanmi OS, Aderinwale A, Abiodun-Adewusi O, Okon IM. Knowledge of Lassa fever and use of infection prevention and control facilities among health care workers during Lassa fever outbreak in Ondo state, Nigeria. Pan Afr Med J. 2018; 30:1-13. https://doi.org/10.11604/pamj.2018.30.56.13125 Mateer EJ, Huang C, Shehu NY, Paessler S. Lassa fever–induced sensorineural hearing loss: A neglected public health and social burden. PLoS Negl Trop Dis. 2018;12(2):1-11. https://doi.org/10.1371/journal.pntd.0006187 Ijarotimi I., Oladejo J., Nasidi A, Jegede O. Lassa fever in the State Specialist Hospital Akure, Nigeria: Case report, Contact tracing and outcome of hospital contacts. Int J Infect Trop Dis. 2016;3(1):20-28. https://doi.org/10.14194/ijitd.3.1.4 Ireye F, Ejiyere H, Aigbiremolen AO, Famiyesin OE, Rowland-Udoh EA, Ogeyemhe CO, Okudo I, Onimisi AB. Knowledge, attitude and infection prevention and control practices regarding Lassa fever among healthcare workers in Edo State, Nigeria. Int J Prev Treat. 2019;8(1):21-27. https://doi.org/10.5923/j.ijpt.20190801.03 World Health Organization. Infection prevention and control assessment framework at the facility level. 2018; 2016:1-15. Available from: https://www.who.int/infection-prevention/tools/core-components/IPCAF-facility.PDF?ua=1 [Accessed on 11 October 2020]. World Health Organization, WHO. Communicable disease surveillance and response systems - Guide to monitoring and evaluating. Epidemic and pandemic alert and response. Published online 2006:90. doi: rr5305a1 [pii] Ousman K, Kabego L, Talisuna A, Diaz J, Mbuyi J, Houndjo B, et al. The impact of Infection Prevention and control (IPC) bundle implementation on IPC compliance during the Ebola virus outbreak in Mbandaka/Democratic Republic of the Congo: A before and after design. BMJ Open. 2019;9(9):1-6. https://doi.org/10.1136/bmjopen-2019-029717 Nzinga J, Mbindyo P, Mbaabu L, Warira A, English M. Documenting the experiences of health workers expected to implement guidelines during an intervention study in Kenyan hospitals. Implement Sci. 2009;4(1):1-9. https://doi.org/10.1186/1748-5908-4-44. Ataiyero Y, Dyson J, Graham M. Barriers to hand hygiene practices among health care workers in sub-Saharan African countries: A narrative review. Am J Infect Control. 2019 May;47(5):565-573. https://doi.org/10.1016/j.ajic.2018.09.014. Gilbert GL, Kerridge I. The politics and ethics of hospital infection prevention and control: a qualitative case study of senior clinicians’ perceptions of professional and cultural factors that influence doctors’ attitudes and practices in a large Australian hospital. BMC Health Serv Res. 2019; 19(212). https://doi.org/1186/s12913-019-4044-y. &nbsp

    Concerns and confidences expressed by teaching staff about the shift of medical education to online mode in South India during the COVID 19 pandemic

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    Background: Online education is prevalent in the country since the beginning of the 21st century. The outbreak of COVID-19, the government declared lockdown, and subsequent closing of institutions was unexpected, and it forced medical colleges to launch online programs for undergraduate courses. Due to the sudden shifting to online mode, most teaching staff members face the challenges of lacking online teaching experience, early preparation, or support from educational technology teams. This institution was in touch with the teachers and students through online mode, enquiring about their welfare and wellness. The present study focuses on concerns and confidences presented by the medical teaching staff on online medical education.  Method: This study was conducted at Jubilee Mission Medical College & Research Institute, a medical college in central Kerala in south India. This institution conducted online classes for undergraduate (UG) medical students through Google classroom and YouTube platforms. There was 186 teaching staff from 21 departments involved in undergraduate (MBBS) teaching in this Institute. In this study, we collected information from the teaching staff about the online classes that they handled. A 27-point survey form was designed using a Google survey and mailed to them. The responses were collected in a week. The data collected was analyzed. Result: Fifty-one members responded. All responding teachers preferred regular classroom teaching due to the provision for better teacher-student interaction. However, one-third of respondents wanted the continuation of online classes, even after resuming classroom teaching. Out of 51 responses, 24 teachers graded the success of the programs more than 90%. The major suggestions received for further improvement of the program were that the departments provided their hardware and software, centralized online sessions for practical purposes, and collected regular feedback from students. Conclusion: The successes of our online teaching programs were limited to didactic teaching only. It could not replace the actual patient examination in a clinical setting, which involves communication skills and emotional relationships. This adversary must be converted into an opportunity to develop e-learning programs. This pandemic should open our eyes, so we learn from it and be better prepared for the future

    Was the world ready to face a crisis like COVID-19?

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    One of the most prominent flaws in the world revealed by COVID-19 is the lack of prior preparation to collectively face international crises. Even at the national level, preparation was meager, as demonstrated by reading the size of the budget approved for health and education versus the budget approved for armament and military actions. It seems that the world was busy preparing for wars and forgot to promote the individual, community, and global health

    Cotrimoxazole as adjuvant therapy in critical ill COVID 19 patients

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    The ongoing pandemic of COVID-19 has forced us to consider using available drugs in the shortfall of vaccines and established treatment. Cotrimoxazole is one of the oldest drugs presently used in the prevention and treatment of opportunistic infections in the human immune deficiency virus (HIV) etc. It is a combination of two drugs Trimethoprim and Sulfamethoxazole. This cost-effective old drug is well tolerated among the population with the concomitant use of folic acid; moreover, it also looks after the secondary infections. To conclude, Cotrimoxazole can be used as critically ill COVID-19 patients.   References Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive care Med. 2020;46(5): 846–48. https://doi.org/10.1007/s00134-020-05991-x Rozin A, Schapira D, Braun-Moscovici Y, Nahir AM. Cotrimoxazole treatment for rheumatoid arthritis. Semin Arthritis Rheum. 2001;31(2):133-41. Bourke CD, Gough EK, Pimundu G, Shonhai A, Berejena C, Terry L, et al. Cotrimoxazole reduces systemic inflammation in HIV infection by altering the gut microbiome and immune activation. Sci Transl Med. 2019;11(486): eaav0537. https://doi.org/10.1126/scitranslmed. aav0537 Liu B, Li M, Zhou Z, Guan X, Xiang Y. Can we use interleukin-6 (IL-6) blockade for coronavirus disease 2019 (COVID-19)-induced cytokine release syndrome (CRS)? J Autoimmun. 2020; 111:102452. https://doi.org/10.1016/j.jaut.2020.102452 Vickers IE, Smikle MF. The immunomodulatory effect of antibiotics on the secretion of tumour necrosis factor alpha by peripheral blood mononuclear cells in response to Stenotrophomonas maltophilia stimulation. West Indian Med J. 2006;55(3):138-41. https://doi.org/10.1590/s0043-31442006000300002 Onyebuagu PC, Kiridi K, Pughikumo DT. Effects of septrin administration on blood cells parameters in humans. Int. J. Basic Appl. Innov. Res, 2014;3(1): 14 -8. https://www.ajol.info/index.php/ijbair/article/view/104688 Ho JMW, Juurlink DN. Considerations when prescribing trimethoprim– sulfamethoxazole. CMAJ. 2011; 183(16):1851-8. https://doi.org/10.1503/cmaj.111152 Mahan CS, Walusimbi M, Johnson DF, Lancioni C, Charlebois E, Baseke J, et al. Tuberculosis treatment in HIV infected Ugandans with CD4 counts .350 cells/mm3 reduces immune activation with no effect on HIV load or CD4 count. PLoS one.2010;5(2): e9138. https://doi.org/10.1371/journal.pone.0009138 Varney VA, Smith B, Quirke G, Parnell H, Ratnatheepan S, Bansal AS, et al. P49 the effects of oral cotrimoxazole upon neutrophil and monocyte activation in patients with pulmonary fibrosis and healthy controls; does this relate to its action in idiopathic pulmonary fibrosis. Thorax. 2017;72: A109. http://dx.doi.org/10.1136/thoraxjnl-2017-210983.19

    Serratia Fonticola microbe presented as a community-acquired urinary tract infection (UTI): a case report

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    Background: The case we are presenting is about one of the rare pathogens, Serratia Fonticola (SF) that may cause urinary tract infection.  Case Presentation: A 58 years-old female presented with dysuria, suprapubic pain, frequency of micturition, and change in urine color. The patient was afebrile on physical examination; however, the urine culture was positive to SF as the sole isolate. The patient received levofloxacin tables (750 mg) once a day for 5 days along with supportive instructions to improve hygiene. On follow-up, she was free of symptoms and the repeated urine culture was negative. Conclusion: This case can be considered globally the third that diagnosed in the urine culture of the asymptomatic patient.   References Geerlings SE. Clinical presentations and epidemiology of urinary tract infections. Microbiol. Spectr. 4, 2016. https://doi.org/10.1128/9781555817404.ch2 Flores-Mireles AL, Walker JN, Caparon M, Hultgren SJ. Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nat Rev Microbiol. 2015 May;13(5):269-84. https://doi.org/10.1038/nrmicro3432 Gavini F, Ferragut C, Izard D, Trinel PA, Leclerc H, Lefebvre B, Mossel DA. Serratia fonticola, a new species from water. International Journal of Systematic and Evolutionary Microbiology. 1979;29(2):92-101. https://doi.org/10.1099/00207713-29-2-92 Aljorayid A, Viau R, Castellino L, Jump RL. Serratia fonticola, pathogen or bystander? A case series and review of the literature. IDCases. 2016 May 24; 5:6-8. https://doi.org/10.1016/j.idcr.2016.05.003 Müller HE. Isolation of Serratia fonticola from birds. Zentralblatt Bakteriol Mikrobiol Und Hyg - Abt 1 Orig A 1986; 261:212–8. https://doi.org/10.1016/s0176-6724(86)80038-4 Garcia ME, Lanzarot P, Costas E, Lopez Rodas V, Marín M, Blanco JL. Isolation of Serratia fonticola from skin lesions in a Nile Crocodile (Crocodylus niloticus) with an associated septicaemia. Vet J. 2008 May;176(2):254-6. https://doi.org/10.1016/j.tvjl.2007.02.025. Bollet C, Gainnier M, Sainty JM, Orhesser P, De Micco P. Serratia Fonticola isolated from a leg abscess. J Clin Microbiol 1991; 29:834–5. https://doi.org/10.1128/JCM.29.4.834-835.1991 Farmer JJ 3rd, Davis BR, Hickman-Brenner FW, McWhorter A, Huntley-Carter GP, Asbury MA, Riddle C, Wathen-Grady HG, Elias C, Fanning GR, et al. Biochemical identification of new species and biogroups of Enterobacteriaceae isolated from clinical specimens. J Clin Microbiol. 1985 Jan;21(1):46-76. https://doi.org/10.1128/JCM.21.1.46-76.1985 Stock I, Burak S, Sherwood KJ, Gruger T, Wiedemann B. Natural antimicrobial susceptibilities of strains of \u27unusual\u27 Serratia species: S. ficaria, S. fonticola, S. odorifera, S. plymuthica and S. rubidaea. J Antimicrob Chemother. 2003;51(4):865-85. https://doi.org/10.1093/jac/dkg156. Gorret J, Chevalier J, Gaschet A, Fraisse B, Violas P, Chapuis M, Anne JG. Childhood delayed septic arthritis of the knee caused by Serratia fonticola. Knee 2009; 16 (6):512–4. https://doi.org/10.1016/j.knee.2009.02.008 Hai PD, Hoa LTV, Tot NH, Phuong LL, Quang VV, Thuyet BT, Son PN. First report of biliary tract infection caused by multidrug-resistant Serratia fonticola. New Microbes New Infect. 2020; 36:100692. https://doi.org/10.1016/j.nmni.2020.100692 Conclusion: This case can be considered globally the third that diagnosed in the urine culture of the asymptomatic patient

    The psychological impact of COVID-19 and the subsequent social isolation on the general population of Karnataka, India

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    Background: The COVID-19 pandemic has various unfavorable effects on individuals and the community. This study aims to assess the psychological impact of the COVID-19 epidemic and the subsequent social isolation on the general population of Karnataka, India.  Methods: A web-based cross-sectional survey was conducted in Karnataka from 8 to 14 April 2020 using the snowball technique. The psychological impact was assessed with the help of the nine-item Patient Health Questionnaire-9 (PHQ-9) and seven-item General Anxiety Disorder-7 (GAD-7) questionnaires. IBM SPSS Statistics Subscription version 16.0 was recruited to analyze the data. Descriptive (Mean + Standard Deviation) and bivariate (Pearson chi-square and ANOVA tests) analysis used to present data with the significance level set at less than 0.05. Results:  This study included 1537 participants from 26 cities in Karnataka. About two-thirds of the respondents were undergraduate students (951, 61.9%), females (768, 50.0%), and 40.1% stayed about 15-20 days in social isolation. The prevalence of depression was 47.0%, and anxiety was 41.5%, respectively, among the surveyed sample. After the analysis, the age group 21-30 year old (P < 0.001), females P < 0.001), urban residents (P = 0.021), and the students (P p < 0.001) were significant for depression. However, only the age group 31-40 years was found to be more susceptible to anxiety. Conclusion: As important as addressing the psychological effects, knowing people at risk of developing mental illnesses will contribute effectively to providing appropriate psychological rehabilitation programs at the right time.   References World Health Organization, Novel Coronavirus (2019-nCoV) Situation Report –1, 21 January 2020. Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200121-sitrep-1-2019-ncov.pdf, [Accessed on 30 August 2020]. Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, Ho RC. Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China. Int J Environ Res Public Health. 2020 Mar 6;17(5):1729. https://doi.org/10.3390/ijerph17051729. World Health Organization, WHO Director-General\u27s opening remarks at the media briefing on COVID-19 - 11 March 2020. Available from: https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020 [Accessed on 13 April 2020] Coronavirus in India: Latest Map and Case Count. Available from: https://www.covid19india.org/ [Accessed 13 April 2020]. Arakal RA. First COVID-19 case in Karnataka: Techie who returned to Bengaluru from US tests positive, (9 March2020). Available from: https://indianexpress.com/article/cities/bangalore/coronavirus-karnataka-first-case-covid-19-bengaluru-6307223/ [Accessed on 13 April 2020] India Today on 24 March 2020. Modi announces lockdown Updates: No panic buying please. Stay indoors, tweets PM. Available from: https://www.indiatoday.in/india/story/pm-modi-address-the-nation-at-8-pm-today-speech-covid-19-coronavirus-live-updates-1659215-2020-03-24 [Accessed on 13 April 2020] Ali Jadoo SA. Was the world ready to face a crisis like COVID-19? Journal of Ideas in Health2020;3(1):123-4. https://doi.org/10.47108/jidhealth.Vol3.Iss1.45 Steptoe A, Shankar A, Demakakos P, Wardle J. Social isolation, loneliness, and all-cause mortality in older men and women. Proc Natl Acad Sci U S A. 2013;110(15):5797-5801. https://doi.org/10.1073/pnas.1219686110 Cao W, Fang Z, Hou G, Han M, Xu X, Dong J, et al. The psychological impact of the COVID-19 epidemic on college students in China. Psychiatry Res. 2020; 287:112934. https://doi.org/10.1016/j.psychres.2020.112934 Taylor HO, Taylor RJ, Nguyen AW, Chatters L. Social Isolation, Depression, and Psychological Distress Among Older Adults. Journal of Aging and Health2018; 30(2): 229–246. https://doi.org/10.1177/0898264316673511 Sim K, Huak Chan Y, Chong PN, Chua HC, Wen Soon S. Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease. J Psychosom Res. 2010;68(2):195-202. https://doi.org/10.1016/j.jpsychores.2009.04.004 Roy D, Tripathy S, Kar SK, Sharma N, Verma SK, Kaushal V. Study of knowledge, attitude, anxiety & perceived mental healthcare need in Indian population during COVID-19 pandemic. Asian J Psychiatr. 2020; 51:102083. https://doi.org/10.1016/j.ajp.2020.102083. Karnataka Population. Available from: http://www.populationu.com/in/karnataka-population [Accessed on 8 April 2020] Sample Size Calculator: Understanding Sample Sizes. Available from: https://www.surveymonkey.com/mp/sample-size-calculator/ [Accessed on 5 March 2020] Toussaint A, Hüsing P, Gumz A, Wingenfeld K, Härter M, Schramm E, Löwe B. Sensitivity to change and minimal clinically important difference of the 7-item generalized anxiety disorder questionnaire (GAD-7). J Affect Disord. 2020; 265:395–401. https://doi.org/10.1016/j.jad.2020.01.032 Williams N. The GAD-7 Questionnaire [Review of the test Generalized anxiety disorder (gad-7) Questionnaire, by R. L. Spitzer]. Occupational Medicine2014; 64(3): 224. https://doi.org/10.1093/occmed/kqt161 Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606. Albert PR. Why is depression more prevalent in women? J Psychiatry Neurosci. 2015;40(4):219-221. https://doi.org/10.1503/jpn.150205 Patten SB, Wang JL, Williams JV, Wang JL, McDonald K, Bulloch ACM. Descriptive epidemiology of major depression in Canada. Can J Psychiatry. 2006; 51:84–90. https://doi.org/10.1177/070674371506000106 Jones C. Student anxiety, depression increasing during school closures, survey finds. EdSorce, 13 May 2020. Available from: https://edsource.org/2020/student-anxiety-depression-increasing-during-school-closures-survey-finds/631224 [Accessed on 29 August 2020]. Frasquilho D, Matos MG, Salonna F, Guerreiro D, Storti CC, Gaspar T, Caldas-de-Almeida JM. Mental health outcomes in times of economic recession: a systematic literature review. BMC Public Health2015; 16:115. https://doi.org/10.1186/s12889-016-2720-y. Ali Jadoo SA. COVID -19 pandemic is a worldwide typical Biopsychosocial crisis. Journal of Ideas in Health2020;3(2):152-4. https://doi.org/10.47108/jidhealth.Vol3.Iss2.58 Prabhu N. Bengaluru urban tops state in per capita income, Kalaburagi last, (20 March 2016). 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    Six months of COVID-19 response in Nigeria: lessons, challenges, and way forward

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    Background: The declaration of COVID-19 as a public health emergency by the World Health Organization necessitated countries across the globe to implement response and mitigation measures. We aimed to assess the Nigerian government\u27s response following six months of detection of COVID-19 in Nigeria. Methods: A narrative review of existing literature on the topic was done. The authors\u27 opinion as experts supporting the COVID-19 pandemic response was included. The review and opinion were summarized, covering six months of the outbreak response in Nigeria. Results: Contact tracing commenced after identifying the index case of COVID-19 in Nigeria but has been faced with challenges such as inadequate equipment and shortage of funds. School closure was implemented barely three weeks after detecting the index case, but the resumption of terminal classes has been announced recently. The Nigerian government implemented restrictions on gatherings involving up to 11 people after three weeks following the detection of the index case of COVID-19. The lack of enforcement and supervision of gatherings and public events made many individuals disregard the restriction measures. Lockdowns on religious gatherings and public events have been recently eased nationwide, and regulatory measures have been put in place. The Nigerian government implemented bans on international travel from all countries, especially high-risk countries. However, the existence of porous borders limited success, which could have been obtained from the travel ban. Conclusion: COVID-19 mitigation measures should be implemented and reinforced as required nationwide and get provided the needed support.   References World Health Organization. COVID-19 public health emergency of international concern (PHEIC) global research and innovation forum, 2020 February 12. In: WHO 2020. 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Okunola A. 5 Challenges facing health care workers in Nigeria as they tackle COVID-19. On 9 June 2020. In: Global citizen. Available from: https://www.globalcitizen.org/en/content/challenges-for-health-care-workers-nigeria-covid/ [Accessed on 26 August 2020]. Sessou E. COVID-19: Why we provided testing kits in Kano- ADF. 2020 May 8. In: Vanguard. Available from: https://www.vanguardngr.com/2020/05/covid-19-why-we-provided-testing-kits-in-kano-adf/ [Accessed on 26 August 2020]. Ilesanmi OS, Afolabi AA. Time to move from vertical to horizontal approach in our COVID-19 response in Nigeria. SciMed J. 2020; 2:28-29. https://doi.org/10.28991/SciMedJ-2020-02-S1-3. Olisa C. Covid-19: FG orders immediate shut down of all schools. 2020 March 20. In: Naira Metrics [Internet]. Available at: https://nairametrics.com/2020/03/20/covid-19-fg-orders-immediate-shut-down-of-all-schools/ [Accessed on 26 August 2020]. Adejayan G. COVID-19: Lagos decontaminates schools for partial resumption. 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