key: cord- -zupx qn authors: ni, yijun; ebido, chike chukwuenyem; odii, elijah chibueze; wang, jinhui; orakwelu, chinemerem hodges; abonyi, francis chukwuemeka; ngene, chinedu innocent; okoro, joseph onyekwere; ubachukwu, patience obiageli; hu, wei; yin, mingbo title: phylogeography and genetic diversity of the copepod family cyclopidae (crustacea: cyclopoida) from freshwater ecosystems of southeast nigeria date: - - journal: bmc evol biol doi: . /s - - - sha: doc_id: cord_uid: zupx qn background: copepods are key components of aquatic ecosystems and can help regulate the global carbon cycle. much attention has been paid to the species diversity of copepods worldwide, but the phylogeography and genetic diversity of copepods in nigeria is unexplored. results: using a mitochondrial cytochrome c oxidase subunit i marker, we preformed phylogenetic and phylogeographic analyses for cyclopidae copepods in southeast nigeria. a high species diversity of cyclopidae in nigeria: species of tropocyclops, species of mesocyclops and species of thermocyclops from cyclopidae were identified in populations. moreover, we detected unique haplotypes, which fell into two distinct clades. pairwise genetic distances (uncorrected p-distances) among the species of cyclopidae ranged from . to . . several species co-existed in the same lake, and some haplotypes were shared among different geographic populations, suggesting a dispersal of cyclopidae in our sampling region. finally, we found that the population genetic diversity for each species of cyclopidae was low in nigeria. conclusions: our findings explored the species diversity and distribution of copepods within the family cyclopidae for nigerian freshwater ecosystems: a high species diversity of cyclopidae copepods was detected over a small geographic sampling range. results from this study contribute to a better understanding of copepod diversity of nigerian freshwater ecosystems. co levels [ ] . thus, much attention has been paid to the bio-diversity of copepods in aquatic ecosystems [ , ] . copepods are the intermediate hosts of the parasitic nematode dracunculus medinensis, which causes a serious guinea-worm disease in nigeria and elsewhere [ ] . humans could become infected by drinking unfiltered water containing copepods which are infected with larvae of d. medinensis. therefore, most studies on copepods from nigeria have focused on their role in the dispersal of the pathogen [ , ] . only a few regional biogeographic studies have been conducted on copepods based on morphological species identification [ ] . for example, based on the morphology, a previous study showed the occurrence of the genera mesocyclops sars, and thermocyclops kiefer, in nigerian freshwater ecosystems: six mesocyclops species and three thermocyclops species were identified [ ] . moreover, it was believed that m. aspericornis was one of the most abundant species of mesocyclops in nigerian waterbodies, and t. decipiens was the most abundant species of thermocyclops from nigeria [ ] . however, the identification of different species of copepods solely based on morphology has technical limitations [ ] , as cryptic species are often detected. therefore, more discerning methods such as dna barcoding are needed to investigate copepod taxonomy, especially to recognize morphologically cryptic genetic lineages [ ] . dna barcoding has already been successfully applied to estimate the species/genetic diversity in many zooplankton taxa [ ] , as it can be used for rapid, accurate, reliable and remote identification of specimens of all metazoan [ ] . a fragment of the mitochondrial cytochrome c oxidase subunit i (coi) gene has proved to be a useful marker for many biodiversity studies [ , ] , as coi has advantages of being effective for species identification from a wider range of metazoan phyla and possessing a phylogenetic signal which can be used over a wider range of taxonomic levels [ ] . the coi marker has been successfully applied to species identification for cladocerans [ , ] . for example, dna barcoding was used to identify sibling cryptic species of the ceriodaphnia cornuta species complex from australia [ ] and to examine species of cladocera, such as daphnia, diaphanosoma, ceriodaphnia, moina and alona, from mexico and guatemala [ ] . this approach has also been applied to copepods [ ] . for instance, a study reported new sequences of marine copepod species by using a coi marker [ ] . elías-gutierrez et al. [ ] examined species of copepoda from mexico and guatemala by applying a coi marker. using coi is highly advantageous because it can also detect cryptic species, a phenomenon that is very common in copepod assemblages [ ] . for example, three genetically divergent but morphologically similar forms of hemidiaptomus (occidodiaptomus) ingens were detected throughout the distribution range of this species complex [ ] . moreover, oithona similis s.l. was found to be a complex of nine cryptic species instead of a single cosmopolitan species, according to a coi and a nuclear ribosomal s genetic marker [ ] . similarly, the nominal species "eudiaptomus hadzici" in the western balkans consists of four cryptic species according to a mitochondrial (coi) and a nuclear (nh ) marker [ ] . dna barcoding often reveals differences between allopatric populations. in that situation, it is difficult to decide whether this indicates different genetic lineages or simply geographical intraspecific variation. for instance, several different genetic lineages of moina which were allopatric in a phylogeny were assigned to a single species, because they had similar morphology [ ] . the phylogeny of copepods had been widely studied using molecular data. recently, a comprehensive study from asia showed a high species diversity of copepods in south korea [ ] . in that study, sequenced individuals represented species belonging to six different orders [ ] . another study has shown that sinocalanus tenellus consists of two very distinct clades in china, suggesting they are parts of a complex of cryptic species [ ] . moreover, karanovic [ ] detected a new species of schizopera from japan, which was the first member of its genus reported in japanese freshwater ecosystems, and it had no close relatives from elsewhere in the world. another study has revised the higher systematics of copepods and proposed the new taxa canuelloida ordo. nov., smirnovipinidae fam. nov. and cyclopicinidae fam. nov. [ ] . use of molecular data has not been restricted to species-level taxonomy [ ] , for example, the phylogeography of copepods has been also frequently investigated. they focused on the genealogical lineages of closely related species of copepods and their geographic distributions, by combining the information from phylogenetics, molecular genetics, population genetics, geology, paleontology, demography, ethology and historical biogeography [ ] . for instance, two species of copepods (i.e. neodiaptomus schmackeri and mongolodiaptomus birulai) occur in chinese taiwan: there was little gene flow among populations for both species [ ] . additionally, four populations of leptodiaptomus cf. sicilis in mexico were found to diverge into distinct phenotypes, and their specialization was further supported by molecular data which showed persistence of a founder effect, limited gene flow, and a pattern of allopatric speciation [ ] . there have been no studies on phylogeography and genetic diversity of copepods from nigeria. in this study, we analyzed copepod populations (out of pools/ lakes sampled) from nigeria. by analyzing sequence variation in the coi gene, we aimed to explore the species diversity and distribution of copepods among these populations. our expectation was to detect several members of the cyclopidae, as it is commonly observed worldwide [ , ] . we also investigated the phylogeography of cyclopidae in nigeria. one to specimens of cyclopidae were sequenced per location, and a total of cyclopidae coi sequences were successfully obtained from freshwater lakes around southeast nigeria, of which unique haplotypes were detected (tables and ). none of the coi sequences exhibited characteristics of nuclear pseudogenes (frame shifts or premature stop codons). two independent species-delimitation methods (i.e. gmyc and bptp) based on the coi bayesian tree consistently iden- (table ) . for each species, the population haplotype diversity (h d ) of coi ranged from to . , and the population nucleotide diversity (π) ranged from to . × − ( table ) . based on the haplotype network, seven out of species detected through analysis of the coi gene occurred at more than one locality in nigeria (fig. b) . the most frequently occurring species in this study was t. cf. prasinus, which had haplotypes and was distributed in lakes, including a g, aor, o m and u h, and one of the haplotypes was shared by lakes (a g, aor, o m). such a pattern was also observed in species m. cf. dussarti, which had haplotypes and one of them was shared by lakes (n o, n o and ubs) (fig. b) . different cyclopidae species co-existed in the same lake. for example, three species (i.e. t. cf. confinis, t. cf. prasinus and t. cf. crassus) co-existed in lake a g (fig. b) . similarly, t. cf. onabamiroi, m. cf. aequatorialis similis and m. cf. salinus co-existed in lake uii (fig. b) . moreover, five out of haplotypes were shared by different lakes (fig. b) . the most abundant haplotype was cth , including specimens shared by a g, a g and ihe. this was followed by cms , shared by n o, n o and ubs, and ctr , shared by a g, aor and o m (fig. b) . four species (i.e. t. cf. onabamiroi, t. cf. mellanbyi, m. cf. ogunnus and m. cf. aequatorialis similis) expressed only one haplotype with a single individual (fig. b) . through analysis of coi sequence variation, we explored the species diversity and distribution of copepods within the family cyclopidae for nigerian freshwater ecosystems, the first such study for west africa. our results suggested a high species diversity of cyclopidae copepods over a small geographic sampling range. high species diversity has already been reported in the copepods from nigeria [ , ] . forty species of cyclopidae copepods from nigeria were described based on morphological characteristics in the s [ ] . here, we did not detect any new species based on molecular data; all the species identified in the present study were described in [ ] . in agreement with a previous study based on morphology [ ] , we found that t. decipiens was the most abundant species of thermocyclops from nigeria. however, m. aspericornis was recorded as the most abundant species of mesocyclops in nigerian waterbodies [ ] , whereas we found that m. cf. dussarti is the most abundant species of the genus mesocyclops. this inconsistency might be explained by the relatively small sampling region in our study in southeast nigeria. globally, high levels of species diversity of copepods have also been reported [ , ] . for example, caligus species were present in chinese taiwan, and many more species remained to be discovered from this region [ ] . similarly, thirteen species of copepoda, including three members of calanoida (diaptomidae) and ten members of cyclopoida (eucyclopinae and cyclopinae), were recorded in chiapas, mexico [ ] . indeed, high species diversity, even in a relatively small area, has often been observed in copepods [ , , ] . for example, a study identified species that belonged to genera of copepods in sagami bay [ ] . another study identified species of copepods in tolo harbour, hong kong, and oithona rigida, o. simplex and paracalanus crassirostris were found to be the most abundant species [ ] . here, we detected species with several species and species complexes across three genera in nigeria; suggesting a high species diversity of cyclopidae in southeast nigeria. in agreement with a previous study of cyclopoida in nigeria [ ] , our results showed that the same species could be found in geographically separate populations, which also suggests that there are not extensive and common cryptic species in these sampled lakes. thermocyclops decipiens has also been detected in antilles, central america, columbia, venezuela, east of the andes, brazil [ ] and congo [ ] , indicating that this species has a wide distribution across continents. in contrast to several copepod species with high genetic divergence over short distances, e.g. tigriopus californicus [ ] , our data showed genetic similarity of the t. decipiens populations from different continents. a similar phenomenon has been detected in some open-ocean copepods which have more obvious dispersal routes. for example, it was found that several mtcoi haplotypes of calanus pacificus were distributed across multiple sampling location from the north pacific ocean [ ] . by using restriction site-associated dna sequencing, no significant genetic differentiation was found among centropages typicus samples collected from different nw atlantic regions with clear connectivity [ ] . zooplankton species often have vast ranges [ , ] . for example, daphnia galeata has been detected in both china and europe with some haplotypes shared across large distances [ ] . birds are often regarded as the key vectors for the dispersal of resting eggs of aquatic zooplankton [ ] , across geographical barriers. we found that different sibling species of cyclopidae co-existed in the same nigerian lake, a common finding in copepods [ ] . for example, a study of the genus mesocyclops conducted in africa reported that m. major and m. ogunnus often co-existed in the same waterbody [ ] . similarly, another study from nigeria reported that (see figure on previous page.) fig. a geographic locations of sampling sites for cyclopidae in nigeria. b haplotype network of cyclopidae from nigeria, based on the coi gene ( bp). each circle represents a unique haplotype and its size reflects the number of individuals expressing that haplotype. color codes denote geographic location of populations. portion of circles indicate distribution of haplotypes among different populations. the number of marks on connecting lines indicates the number of mutations between haplotypes. for lake abbreviations see table . the map was obtained from arcgis and edited in adobe illustrator fig. bayesian phylogenetic tree and species delimitation results for cyclopidae from nigeria, based on the coi gene ( bp). the ids for shared haplotypes are provided in table ; for origin of reference sequence ids see table s . only posterior probabilities > . are shown. species delimitation according to the gmyc and bptp methods are indicated. for the bptp method, the statistical support (pp) for species membership is also shown. paracalanus parvus was used as an outgroup it was common for up to mesocyclops species coexisted in a single locality [ ] . sympatry provides a possibility for interspecific hybridization, which is believed to be a common phenomenon in zooplankton [ ] . hybridization has often been observed in copepods. for example, hybrids between calanus glacialis and c. finmarchicus were detected along the atlantic and arctic canadian coast [ ] . another study also found that hybridization occurred between a female neocalanus cristatus and a male n. plumchrus, and was then followed by backcrossing to a n. plumchrus individual [ ] . our molecular data indicated paraphyly between thermocyclops and mesocyclops, which might reflect introgression resulting from hybridization [ ] . paraphyly has also been observed in other zooplankton, for example, in the daphnia pulex species complex [ ] and moina [ ] . future studies and nuclear markers are needed to investigate gene introgression among the copepod species from nigeria. here, cyclopidae in nigeria showed a high species diversity, but for each species, the haplotype diversity and nucleotide diversity were rather low. consistently, low haplotype and nucleotide diversities were observed in the copepods calanus finmarchicus [ ] , c. agulhensis and c. sinicus [ ] . patterns of population genetic diversity could be caused by different evolutionary forces, such as mutation, migration, genetic drift and natural selection. how these evolutionary forces affect the population genetic diversity depends on many factors, including species' response to environmental changes, and the past and present sizes of the population [ ] . another explanation might be that the structuring of a metapopulation together with founder effects resulted in low population genetic diversity [ , ] . however, the limited sampling of each species among populations cannot be ruled out as a cause for their low genetic diversity in this study. in conclusion, our data revealed a high species diversity of cyclopidae in southeast nigeria: twelve species were detected. our geographical sampling scale in this study was quite small, and therefore, further studies are called for a comprehensive understanding of species distribution and genetic diversity of cyclopidae in west africa. copepod specimens were collected from freshwater lakes around southeast nigeria (fig. a and table ). samples were collected using a -μm plankton net hauled vertically through the water column at three different sites per location. samples collected from different sites in the same location were pooled together and preserved in % ethanol. all specimens were identified morphologically according to the morphological description of copepods in nigeria [ ] [ ] [ ] ] , which also worked as taxonomic keys in this paper. copepods were processed for molecular analyses ( table ). the cephalosome portion of the prosome was obtained from each individual copepod to avoid dna contamination from prey items in the gut, using a microscopic tweezer and a sharp blade under the stereomicroscope. total genomic dna was extracted from the head using h buffer with proteinase k ( μl), containing mm tris-hcl, . m kcl, . % tween , . % np- and mg/ml proteinase k (merck, germany). samples were incubated overnight at °c in a water-bath with mild shaking. the proteinase k was irreversibly denatured after a -min incubation at °c. the homogenate was centrifuged briefly and stored at °c before use. a base-pair fragment of the coi gene was amplified using the consensus primer pair (forward: ′-ggt caa caa atc ata aag ata ttg g − ′; reverse: ′-taa act tca ggg tga cca aaa aat ca - ′ [ ] ;). polymerase chain reaction (pcr) was carried out in a total volume of μl, consisting of μl x pcr buffer ( mm tris-hcl, ph . , mm mgcl , mm kcl), μl . mm of each dntp, μl . μm of each primer, . μl water, units of taq dna polymerase (supertherm dna polymerase, taq hs from takara bio inc., california, usa) and μl of genomic dna. the pcr thermocycle protocol was as follows: denaturation at °c for min, then cycles of min at °c, . min at °c and . min at °c; followed by a final elongation at °c for min. the success of amplification was checked using agarose gel electrophoresis. afterwards, the pcr products were purified (high pure pcr product purification kit, roche diagnostics) and sequenced in the forward direction on an abi prism dna capillary sequencer by invitrogen trading co., ltd. (china). chromatograms were checked for ambiguous base calling and errors in base calling were corrected using mega [ ] , and the phred quality scores of the sequences were examined with chromas lite version . (technelysium pty. ltd., south brisbane, australia). sequences with double peaks or noise were re-sequenced in the reverse direction, and only chromatograms of high quality were applied to the following genetic analyses. all newly obtained sequences were submitted to genbank under accession numbers mn -mn . we identified unique haplotypes in dnasp . [ ] . muscle [ ] implemented in mega was used to align the sequences that were subsequently translated into amino acids to examine the presence of stop codons. afterwards, all haplotypes were aligned, together with reference sequences obtained from genbank (table s ), using the clustal w algorithm [ ] in mega . then, all the sequences were timed to a uniform length of bp in mega . for each species, the number of haplotypes (n ), haplotype diversity (h d ) and nucleotide diversity (π) per population (populations with sample size less than were excluded) were calculated in dnasp . . the test of xia et al. [ ] implemented in dambe [ ] was used to inspect potential loss of phylogenetic signal resulting from substitution saturation at the coi locus. a phylogenetic tree was then constructed using the bayesian method in beast [ ] , with a tree sampled every generations among , , , a burn-in of %, and the final , trees summarized using treeannotator. the best-fitting substitution model was gtr + g + i according to the corrected akaike information criterion in jmodeltest v. . . [ ] . we applied a strict molecular clock and set other tree priors to their default values. tracer v . [ ] was applied to ensure that enough generations were computed. paracalanus parvus, a member of the calanoida phylogenetically close to cyclopoida, was used as an outgroup. to test the hypothesis that the cyclopidae in nigeria contains high biodiversity, two independent species delimitation methods were applied: the general mixed yule coalescent model (gmyc [ ] ) and poisson tree processes methods (ptp [ ] ). the gmyc model is a likelihoodbased method using an ultrametric tree to delimit species by fitting within-and between-species branching models to reconstruct gene trees. we performed the gmyc modeling using the "splits" package [ ] in r . [ ] and conducted the ptp calculations on the bptp webserver (http://species.h-its.org/ptp/), with , markov chain monte carlo (mcmc) generations, thinning set to , burnin at % and a bayesian search performed. the input phylogenetic tree was generated using beast (see above). a network of coi haplotypes was then constructed to visualize genetic relationships among populations using haploviewer [ ] . the maximum likelihood tree inferred with mega using the best model gtr + g + i (by jmodeltest v. . . ) was applied as input. uncorrected pairwise genetic distances between species were calculated in mega based on coi. supplementary information accompanies this paper at https://doi.org/ . /s - - - . additional file : table s . list of reference coi sequences of cyclopidae (from south korea, brazil and china) and the outgroup used in this study. abbreviations coi: mitochondrial cytochrome c oxidase subunit i gene; pcr: polymerase chain reaction; bp: base pairs; gmyc: the general mixed yule coalescent model; ptp: poisson tree processes methods an introduction to copepod diversity. london: ray society copepod evolution. london: the ray society climatic warming and the decline of zooplankton in the california current entomology for the copepodologist high diversity of caligus species (copepoda: siphonostomatoida: caligidae) in taiwanese waters how many copepods mismatch between marine plankton range movements and the velocity of climate change reorganization of north atlantic marine copepod biodiversity and climate the value of the world's ecosystem services and natural capital phase transitions of wax esters adjust buoyancy in diapausing calanoides acutus climate change and marine plankton molecular phylogeny of the calanoida (crustacea: copepoda) cladistic analysis of the calanoid copepoda a survey of predilection sites and degree of disability associated with guineaworm (dracunculus medinensis) dracunculiasis in the north eastern border of ebonyi state, south eastern nigeria progress in dracunculiasis eradication in oyo state, south-west nigeria: a case study four new species of cyclops sensu lat. 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linguistic help, and the anonymous reviewer for useful comments on the earlier version of this manuscript. authors' contributions my designed the study, ce, eo, co, fa, cn, jo and pu collected samples, yn and jw carried out the molecular work. yn, wh and my contributed to data analyses. my wrote the manuscript with the help of yn. all authors read and approved the final version. this research was funded by the national natural science foundation of china ( ) and natural science foundation of shanghai ( zr ) to my. the funding bodies played no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript. all the sequencing data are available via ncbi (under accession numbers mn -mn ). collection of zooplankton (copepods in this study) did not require specific permissions because these samples were obtained from unprotected lakes that are open for public activities. our study did not involve the use or collection of endangered or protected species. not applicable. the authors declare that they have no competing interests. key: cord- -g n n authors: ekpenyong, bernadine; obinwanne, chukwuemeka j.; ovenseri-ogbomo, godwin; ahaiwe, kelechukwu; lewis, okonokhua o.; echendu, damian c.; osuagwu, uchechukwu l. title: assessment of knowledge, practice and guidelines towards the novel covid- among eye care practitioners in nigeria–a survey-based study date: - - journal: int j environ res public health doi: . /ijerph sha: doc_id: cord_uid: g n n the aim of this study was to explore knowledge, practice of risk and guidelines of the novel corona virus disease (covid- ) infection among the eye care practitioners and the potential associated factors. a cross-sectional self-administered online survey was distributed via emails and social media networks between nd and th may corresponding to the week of the lockdown in nigeria to eye care practitioners (ecps). data for respondents were analyzed. knowledge and risk practice were categorized as binary outcome and univariate and multivariate linear regression were used to examine the associated factors. the mean score for covid- -related knowledge of public health guidelines was high and varied across the ecps. ophthalmic nurses, ophthalmologists and optometrists showed higher covid- -related knowledge than other ecps (p < . ), particularly those working in the private sector. more than % of ecps stated they provided essential services during the covid- lockdown via physical consultation, particularly the ophthalmologists. most respondents reported that the guidelines provided by their association were useful but expressed their lack of confidence in attending to patients during and after the covid- lockdown. compared to other ecps in nigeria, more ophthalmic nurses received training in the use of personal protective equipment (ppe). this survey is the first to assess knowledge, attitudes and practice in response to the covid- pandemic in nigeria. ecps in nigeria displayed good knowledge about covid- and provided eye care services during the covid- lockdown in nigeria, despite the majority not receiving any training on the use of ppes with concerns over attending to patients. there is need for the government to strengthen health systems by improving and extending training on standard infection prevention and control measures to ecps for effective control of the pandemic and in the future as essential health workers. the emergence of the novel coronavirus disease in in december in the city of wuhan, the chinese province of hubei city, halted the ever-busy human society and threatened every nation [ ] . a completely different type of acute pneumonia [ ] which had close resemblance to the previous middle east respiratory syndrome (mers) and severe acute respiratory syndrome (sars) viruses but appeared to be much more lethal than the two was reported [ ] . the infection soon became a cause of concern with the world health organization, declaring the rapid spread of cases of covid- a pandemic on th march, and recommended that a globally coordinated effort was needed to fight the pandemic [ ] . while there is currently no vaccine for covid- [ ] , the symptoms can include fever, flu-like symptoms such as a cough, sore throat and fatigue and/or shortness of breath, diarrhea, nausea and vomiting [ ] . the risk of death in covid- -infected individuals increases with older age, presence of hypertension, diabetes and coronary heart diseases [ ] . there are also reports of conjunctivitis and transmission of the virus by aerosol contact with conjunctiva [ ] with some uncertainty as to whether the virus is evident in human tears [ ] . on the th of january , sub-saharan africa's first confirmed case of covid- was announced in nigeria. this led to the activation of the country's national coronavirus emergency operation centre by the government. during to the ebola outbreak of , of the , confirmed cases, there were over suspected cases in west africa, but this was controlled in just days [ ] . currently, the control of covid- is becoming challenging for the nigerian government despite the mobilization of resources and manpower by the nigeria centre for disease control ncdc [ , ] . there are about , confirmed cases of covid- and lost lives of humans from the infection ( june ). the majority of the cases are in the former capital city of lagos ( cases, deaths), federal capital city of abuja ( cases, deaths) and kano ( cases, deaths) [ ] . as the country continues to experience steady increase in the number of confirmed cases [ ] , the different levels of government have taken proactive steps to curtail the spread of coronavirus throughout the country. movements were restricted within and between states, and the society observed a partial lockdown in response to the pandemic. current evidence suggests that the implementation of outbreak response strategies for covid- can limit the disease. however, these situational responses affect businesses including their interactions with relevant regulators/professional bodies causing the government to respond through the nigerian national assembly's emergency stimulus bill, the central bank of nigeria's policy measure which dedicated its credit facility to develop the healthcare sector [ ] . unlike some businesses and occupations considered as essential services, eye care professions (ecp) discontinued operations during the lockdown denying many patients-particularly those in need of emergency care or receiving routine injections for management of blinding eye diseases such as diabetes macular edema-access to eye care. ecps may be susceptible to infection due to close patient proximity during examination such as slit lamp examination, applanation tonometry and the potential contamination of instruments [ ] ; however, medical visits related to systemic and ocular disease or injury where there is significant risk of permanent vision loss because of any postponement of care, as determined by the treating ecp, are considered essential visits [ ] . other conditions considered by ecps as essential services have been summarized in table . additionally, the same groups burdened by covid- complications could also suffer more vision problems including individuals with hypertension, respiratory conditions, and heart disease and the elderly [ ] . patients who have lost or broken their glasses or contact lenses with consideration given to prescription needs and level of disability without correction are considered as essential services [ ] . there are also concerns existing around the pandemic with various reports from news outlets and social media reporting how best to limit the chance of infection, with significant amounts of misinformation and speculation [ ] which many patients may request clarification from their ecps to keep them safe through this period. the aim of this study was to assess knowledge and practice of covid- exposure risk among ecps as well as understand their confidence in current federal ministry of health (fmoh) guidelines for identifying possible covid- cases, knowledge of personal protective equipment (ppe) recommendations and training in its usage when managing such cases. the impact of covid- lockdown among practitioners was also assessed. this survey is among the first to assess knowledge level, practice of risk and awareness of the guidelines for consulting patients at risk or confirmed cases of covid- in nigeria incorporating responses from all tiers of ecps in nigeria. the findings will also provide first evidence on ecps' knowledge of covid- in nigeria. this will help to reduce their risk, and that of their family, of contracting the virus, reduce morbidity and mortality associated with being infected. evidence from the study can also be used to implement emergency policies to counter the spread and impact of a similar outbreak in future. the study will provide clarity on the essential nature of ecps services to help policy making in future outbreaks. this study on the knowledge, practice, impact and guideline on covid- was conducted among eye care practitioners in nigeria. according to the world bank group ( ), nigeria has an estimated population of , , people. majority of eye care service practitioners are located in the cities [ ] . nigeria is home to registered optometrists [ ] , about ophthalmologists [ ] , ophthalmic nurses [ ] and dispensing opticians [ ] . all eye care practitioners practicing in nigeria have overlapping roles without distinct borders. ophthalmologists undergo a minimum of four ( ) years postgraduate training after a medical degree and provide surgical as well as medical eye care [ ] . optometry is a licensed professional program completed in a minimum of six ( ) years leading to the award of doctor in optometry (od) which empowers optometrists to provide general eye care including treating eye diseases, refractive errors, low vision and contact lenses [ ] . an ophthalmic nurse has a one-year post-basic nursing training in eye care and work with other ecps to engage in blindness prevention activities and care for patients for ocular surgeries. dispensing opticians obtain a three-year national diploma and work in optical laboratories to interpret and dispense optical prescriptions [ ] . a self-administered questionnaire developed and used previously for ecps [ ] was modified and pre-tested to ensure that it was suitable for use in nigeria. the initial survey was piloted among optometrists who were not part of the study team and did not participate in the final survey to ensure clarity and understanding as well as to determine the duration for completing the questionnaire prior to disseminating them. the study adhered to the principles of the helsinki declaration (wma, ) and the protocol was approved by the human research ethics committee of the cross river state ministry of health, nigeria (ref #: crsmoh/rp/rec/ / ). participation was anonymous and voluntary. informed consent was obtained from all participants prior to commencement of the study and after the study protocol has been explained. participants consented to voluntarily participate in this study by answering either a 'yes' or 'no' to the question inquiring whether they voluntarily agree to participate in the survey. a 'no' response meant that the participants could not progress to answering the survey questions and were excluded from the study. the required sample size for this study was determined using a single population proportion formula given as: in the absence of similar studies in nigeria, the study assumed a proportion of % of the population and used a desired precision of % and % confidence level for a two-sided test. to make up for non-response rate of %, the sample size was determined to be persons, which was adequate to detect statistical differences in the analysis of online cross-sectional study on covid- among ecps in nigeria. respondents were proportionately determined across the categories of ecps. a self-administered anonymous online survey was administered using convenience sampling technique, on a first-come bases until the required number was obtained within the one-month duration of the survey. a total of questionnaires were fully completed and retrieved in the estimated proportions for the different categories of ecps except for ophthalmic nurses where we got less than the required sample (ophthalmologists [n = ], optometrists [n = ], ophthalmic nurses [n = ] and dispensing opticians [n = ] ). the survey was created in survey monkey and disseminated to registered ecps in nigeria including optometrists, ophthalmologists, opticians, ophthalmic nurses, and ophthalmic technicians between nd and th may . distribution was through the administrative heads of the various professional bodies including the ophthalmological society of nigeria (osn), nigerian optometric association (noa), nigeria ophthalmic nurses association (nona) and association of nigerian dispensing opticians (ando) and individually. a link to the online survey was disseminated via the emails and social media platforms (facebook and whatsapp) of the different professional organizations. survey link remained active from may to may , within which time participants completed the survey. the practitioners did not receive incentives for participating in the study and were not under any obligation to complete the survey. participants included ecps who were currently registered to provide clinical services at different levels of eye care within nigeria at the time of the study. responses from non-ecps, non-nigerians, ecps practicing outside nigeria, and non-practicing practitioners were excluded from the analysis. the survey tool was shown in table s and consisted of items divided into five sections (demographic characteristics, knowledge, practice of risk of contracting the infection, impact and guidance) utilizing closed-ended questions and a four point 'likert-type scale' to score participants' responses. the responses ranged from 'yes' (score ' ) to 'no' (score '- ). a 'not sure' response was scored as 'zero'. for responses utilizing likert scale, the scores ranged from ' for 'extremely confident' to ' for confident and '- was scored for 'not-confident' the impact of covid- pandemic on practitioners, their family members and practices, including questions on their confidence in the current fmoh guidelines for identifying possible covid- cases, their knowledge of personal protective equipment (ppe) recommendations, and training in its usage during consultation were assessed. the explanatory (independent) variable included basic characteristics and explanatory factors including gender, age in categories, region of practice, level of education, marital, employment and religion status, type of ecp, practice setting and practice years. the dependent variables in the regression analysis was knowledge relating to covid- . the total score ranged from to . the scores were derived from questions inquiring on 'whether the participants knew the occupation classified as 'essential work' by the ministry of health during the covid- lockdown', if ecps could correctly identify from a list of nine items, the recommended ppes by the ncdc in preventing covid- transmission, during consultation of confirmed/suspected cases for health care workers? descriptive statistics and multivariable analysis were performed to demonstrate the outline of the findings of this study and sample characteristics. the responses were presented descriptively in tables. first, the entire cohort-men and women-was analyzed -to determine the knowledge towards covid- . then, chi-square tests were used to examine the variability in responses by gender, for the different ecps, concerning the knowledge, practice and understanding of the guidelines of the fmoh. the variability in responses between ecps from the different specialties concerning their understanding of guidelines was also assessed. univariate linear regression analysis was calculated in order to assess the unadjusted coefficient. all confounding variables with a p value < . were retained and used to build a multivariable linear regression model. a manual stepwise backwards model was used to estimate the adjusted estimate for independent variables and to determine factors associated with kap scores towards covid- . a p-value ≤ . was considered statistically significant and we checked homogeneity of variance and multicollinearity using variance inflation factors (vif). all statistical analyses were carried out using the statistical program for social sciences, version . (spss inc, chicago, illinois, usa). a total of respondents (males, n = , . %, females n = , . %) aged - years (mean age ± sd, ± years) completed the online questionnaire. about . % were aged less than years and male respondents were significantly older than the females ( ± years, % ci - . versus ± years, % ci . - . ; p = . ). table presents the demographic characteristics of the respondents including their employment status and years of practice. the total knowledge score relating to covid- ranged from to with a mean score of . ± . . figure shows the mean knowledge score for each eye care profession in the survey. there was a significant difference in the mean knowledge score between the professions (one way analysis of variance, p < . ) with post hoc analysis revealing that the differences was only when ophthalmic nurses ( . ± . ), optometrists, ophthalmologists ( . ± . and . ± . , respectively) were compared with the opticians ( . ± . , p < . ) who had the least knowledge of covid- transmission. no other multiple comparison showed significant difference. in the multivariable analysis, we found that, after adjusting for all cofounders in the final model, eye care profession (job title) was the only factor associated with knowledge of risk towards covid- (adjusted coefficient, − . , % confidence interval − . , − . ; p < . ) ( table ). in the multivariable analysis, we found that, after adjusting for all cofounders in the final model, eye care profession (job title) was the only factor associated with knowledge of risk towards covid- (adjusted coefficient, - . , % confidence interval - . , - . ; p < . ) ( table ) . table shows the opinion of ecps with respect to covid- during the lockdown. over % of the subjects reported lack of confidence in the guideline of the federal ministry of health did not consider eye care workers as "essential workers" during the lockdown. notwithstanding, . % were either not so confident or not at all confident attending to any patient during the lockdown while . % also reported they were not so confident or not all confident attending to covid- patient or those at risk of covid- . when questioned about their level of confident attending to patients after the lockdown, . % of eye care professionals reported lack of confident attending to patients even after the lockdown is over and for majority of the practitioners ( %), covid- will change the way the deliver eye care service in their practice. the results also revealed that a high proportion of eye care professionals provided eye care services to patients during the lockdown (figure ) with more ophthalmologists and an equal proportion of optometrists and ophthalmic nurses providing services. of the various means of consultation during the lockdown (figure ) , it can be seen that many ophthalmologists ( %), optometrist and ophthalmic nurses ( % and %, respectively) did so via physical consultations in the clinic. more optometrist than ophthalmologist ( . % vs. . %) utilized videoconferencing to provide this much-needed service during the lockdown while consultation over the phone, social media were also utilized by ecps during the lockdown (figure ). compared to other practitioners, a significant higher percentage of optometrists reported that their professional association provided information on guidelines during covid- ( figure ) . for over % of the respondents from each eye care profession, the guidelines were useful and regarding the use of personal protective equipment (ppe), less than % of each eye care professionals received training on the use of ppe in the control of covid- . slightly more ophthalmic nurses ( . %) received training on ppe compared to the ophthalmologists ( . %) but this was at borderline significance (p = . ) (figure ). % % % % % % % % % % compared to other practitioners, a significant higher percentage of optometrists reported that their professional association provided information on guidelines during covid- ( figure ). for over % of the respondents from each eye care profession, the guidelines were useful and regarding the use of personal protective equipment (ppe), less than % of each eye care professionals received training on the use of ppe in the control of covid- . slightly more ophthalmic nurses ( . %) received training on ppe compared to the ophthalmologists ( . %) but this was at borderline significance (p = . ) (figure ). compared to other practitioners, a significant higher percentage of optometrists reported that their professional association provided information on guidelines during covid- ( figure ). for over % of the respondents from each eye care profession, the guidelines were useful and regarding the use of personal protective equipment (ppe), less than % of each eye care professionals received training on the use of ppe in the control of covid- . slightly more ophthalmic nurses ( . %) received training on ppe compared to the ophthalmologists ( . %) but this was at borderline significance (p = . ) (figure ) . this is the first study to assess the knowledge, attitude and guidelines of all tiers of ecps regarding the public health initiatives for the novel coronavirus in nigeria. the study found that knowledge about covid- preventive guidelines was high among ecps and ophthalmic nurses, ophthalmologists and optometrists were significantly more knowledgeable compared to opticians. the majority of the ecps did not receive training on the proper use of ppes despite a significant proportion stating that they attended to patients during the lockdown period. although the majority of the ecps felt that their professional association provided some useful information on guidelines during the pandemic, this was considered grossly inadequate for many of the ophthalmologists and ophthalmic nurses. more than half of the ecps expressed lack of confidence in caring for patients at risk of covid- and, for more than a quarter of them, this will continue even after the lockdown is over. similarly high covid- -related knowledge was reported in the general nigerian population [ ] , and that of the chinese population [ ] as well as those of the health care practitioners [ ] but an earlier survey found a lack of understanding of the public health guidelines related to covid- among ecps in the uk. the study included ecps (ophthalmologists, optometrists, ophthalmic nurses and healthcare assistants) [ ] . compared to the uk study, the present study found high knowledge scores among respondents and this difference may be related to timing of both studies as the time lag may have allowed for the respondents in the present study to learn more about covid- and, as such, demonstrated higher knowledge scores. at the time of the uk study, the coronavirus outbreak had just been designated a pandemic by the who [ ] , although the first confirmed case was reported in the uk on january . the significant association found between covid- -related knowledge and the category of ecp may be attributed to the ophthalmic nurses having more training on ppes than other ecps, which may have translated to the higher knowledge scores. although the nigerian federal ministry of health do not consider ecps as essential workers, a large proportion of the respondents disagreed with this and more than half confirmed that they provided emergency eye care services via physical examination of patients during the lockdown. this finding suggests the need to consider the inclusion of ecps as part of the essential healthcare team since ocular emergencies can occur at any time and viral conjunctivitis may be a symptom of covid- [ , ] . several guidelines to limit the risk of infection and help ecps safely provide eye care services have been published by the ophthalmic associations, societies and researchers during the pandemic [ , , , [ ] [ ] [ ] [ ] [ ] [ ] . this is vital as several procedures involve the practitioner to be in close proximity to patients and as such proper use of ppe is essential. a survey of optometrists and opticians conducted in austria, germany and switzerland reported that over % of the ecps planned to wear masks during refraction, contact lens fitting and practiced hand washing and disinfection before performing procedures [ ] . however, training in the use of ppe is important to avoid the ecp being infected. the finding that majority of ecps did not receive any training on proper use of ppes, was concerning and potentially dangerous, as it puts the practitioner at high risk of contracting covid- [ , ] . an interesting finding of this study was the increased use of telemedicine for delivering eye care services during the covid- pandemic, although only a few utilized this service. there is need for education on the methods of delivering this service and the associated benefits for ecps in nigeria. in addition, the fact that majority of the participants in this study were optometrist may be a reflection of the higher number of registered optometrists compared to ophthalmologists and the fact that most of them are practicing in urban centers [ ] . this study has some limitations. firstly, the majority of the respondents were practicing in urban areas and their responses may not represent that of ecps practicing in rural areas. secondly, the low number of responses from ophthalmic nurses was lower than estimated from their registry, and this may affect the responses obtained from the group. future studies should consider other ways of reaching this subgroup as their knowledge and practice as front-line workers is important. in addition, further studies are needed to investigate the knowledge and preparedness of ecps in rural settings to provide service during the covid- pandemic in nigeria. despite these limitations, this study is strengthened by the larger sample size compared to a previous study [ ] . another strength of this study was the representation of the opinions of all tiers of ecps who are involved in the delivery of eye care services during the lockdown in nigeria. in addition, the study was the first to provide evidence on knowledge, practice and guidelines of african ecps during a pandemic. it identified major gaps in the ability of the ecps to continue providing care during and after the pandemic which, if not addressed, might put the ecps and their patients at risk of contracting the virus infection during consultation. addressing these gaps is important to build confidence among ecps and their patients during a pandemic and, more so, as most african countries prepare for a possible second wave of the virus. this study demonstrated that ecps in nigeria were knowledgeable about covid- and readily explored several avenues to serve the nigerian population during the covid- lockdown. however, the ecps reported lack of confidence on the non-inclusion of eye care workers as essential in the government guidelines for the control of this pandemic, which places them at increased risk. therefore, to ensure that ecps continue to provide the needed services during the pandemic or similar events, there is need for training on the proper use of ppe and recognition as essential worker; this will, in turn, boost their confidence when attending to patients even after the lockdown. the nigerian government need to strengthen health systems by improving and extending training on standard infection prevention and control measures for effective control of the pandemic. supplementary materials: the following are available online at http://www.mdpi.com/ - / / / /s , table s : survey tool used in this study. funding: this research did not receive any funding. deadliest enemy: our war against killer germs world health organization declares global emergency: a review of the novel coronavirus (covid- ) clinical and ct features in pediatric patients with covid- infection: different points from adults who declares covid- a pandemic the covid- pandemic: important considerations for contact lens practitioners coronavirus disease : coronaviruses and blood safety clinical course and risk factors for mortality of adult inpatients with covid- in wuhan, china: a retrospective cohort study sars-cov- may be related to conjunctivitis but not necessarily spread through the conjunctiva sars-cov- and conjunctiva nigeria responds to covid- ; first case detected in sub-saharan africa covid- nigeria. nigeria centre for disease control briefings: nigerian emergency economic stimulus bill: all you need to know; brooks and knights legal consultants novel coronavirus disease (covid- ): the importance of recognising possible early ocular manifestation and using protective eyewear policy institute's response to covid- : doctors of optometry essential care guidelines for covid- pandemic knowledge, attitude, and practice regarding covid- among healthcare workers in henan strengths, challenges and opportunities of implementing primary eye care in nigeria odorbn. legislation lagos: optometrists and dispensing opticians registration board of nigeria (odorbn). . available online international council of ophthalmology nigerian nurses decry lack of suitable eyecare facilities ophthalmology training in nigeria: the trainee ophthalmologists' perspective. niger dispensing opticianry calabar: college of health technology survey of ophthalmology practitioners in a&e on current covid- guidance at three major uk eye hospitals survey data of covid- -related knowledge, risk perceptions and precautionary behavior among nigerians. data brief , , knowledge, attitudes, and practices towards covid- among chinese residents during the rapid rise period of the covid- outbreak: a quick online cross-sectional survey assessing viral shedding and infectivity of tears in coronavirus disease (covid- ) patients protecting yourself and your patients from covid- in eye care protective equipment (ppe) for coronavirus disease (covid- ): interim guidance precautionary measures needed for ophthalmologists during pandemic of the coronavirus disease (covid- ) guidance for risk assessment and public health management of healthcare personnel with potential exposure in a healthcare setting to patients with coronavirus disease (covid- ) preparing for a covid- pandemic: a review of operating room outbreak response measures in a large tertiary hospital in singapore. can ophthalmology practice during the covid- pandemic pandemic: survey of future use of personal protective equipment in optometric practice acceptability and necessity of training for optimal personal protective equipment use perception of job-related risk, training, and use of personal protective equipment (ppe) among latino immigrant hog cafo workers in missouri: a pilot study estimated number of ophthalmologists worldwide (international council of ophthalmology update): will we meet the needs acknowledgments: the authors are grateful to the nigerian optometric association for their financial contribution for data collection. the authors declare no conflict of interest. key: cord- -j ov nes authors: otuonye, n. m.; olumade, t. j.; ojetunde, m. m.; holdbrooke, s. a.; ayoola, j. b.; nyam, i. y.; iwalokun, b.; onwuamah, c.; uwandu, m.; salako, b. l.; abayomi, a.; osibogun, a.; bowale, a.; osikomaiya, b.; thomas, b.; mutiu, b.; odunukwe, n. n. title: clinical and demographic characteristics of covid- patients in lagos, nigeria: a descriptive study date: - - journal: nan doi: . / . . . sha: doc_id: cord_uid: j ov nes introduction: covid- is an emerging, rapidly evolving global situation, infecting over million people and causing more than , deaths. several signs and symptoms have been described to be characteristic of the disease. however, there is a dearth of report on the description of the clinical characteristics of the disease in patients from nigeria. this study was designed to provide a description of the clinical and demographic characteristics of covid- patients in nigeria. methods: this study is a case series that includes patients that are evaluated between june and august , , and diagnosed with covid- . patient health records were reviewed and evaluated to describe the clinical characteristics on presentation. results: a total of covid- patients were included in this study, with a mean age (s.d.) of . ( . ). most of the patients survived (mortality rate of . %), and were symptomatic ( . %). there were more males ( . %) than females, and the most common symptoms were fever, breathing difficulty, dry cough and malaise. co-morbidities were also present in almost half of the study participants ( . %). conclusion: this study presents the most extensive description, to date, on the clinical and demographic characteristics of covid- patients in nigeria. males are more likely than females to be infected with covid- and the most occurring symptoms are fever, breathing difficulty, malaise, dry cough and chest pain. old age and the presence of co-morbidities may also be associated with developing the severe disease. key words: covid- , sars-cov- , signs, symptoms, nigeria. covid- is an emerging, rapidly evolving global situation which was first identified in december , in the hubei province of wuhan, china. the disease that has grown into a pandemic is caused by the severe acute respiratory syndrome coronavirus- (sars- and has infected more than million people globally, causing the death of more than , people [ , ] . the distribution of diseases is described in terms of person, place and time or who, where and when [ ] . according to chan et al. [ ] and andersen et al. [ ] , the initial outbreak seemed to be as a result of a zoonotic transmission from bats. however, as the outbreak continued, it was evident that human to human transmission of the virus via close contact was also possible through close contact with an infected person and through respiratory droplets, saliva or discharges from the nose when an infected person coughs or sneezes [ ] . the clinical signs and symptoms of covid- ranges in patients ranges from being absent (asymptomatic infections) to the mild or moderate infection with symptoms such as fever, dry cough, abdominal pain, fatigue, aches and pains, sore throat, breathing difficulty, diarrhoea, headache, conjunctivitis, loss of smell and/or taste, skin rash, and so on. those who develop the severe disease exhibit more serious symptoms such as acute respiratory distress syndrome (ards), multiple organ failure and ultimately death [ ] [ ] [ ] [ ] . treatment remains largely supportive with the severe cases requiring oxygen supplementation and intensive care [ ] . there are no approved vaccines yet for covid- . the first case of covid- in nigeria was identified on th february in a visiting italian. since then, the epidemic in nigeria has resulted in more than , cases and causing more than , deaths (mortality rate of . %) as of september st, [ ] . more than one-third ( . %) of the cases in nigeria were recorded in lagos, nigeria [ ] . the epidemic in nigeria has resulted in patients presenting with different symptoms and there is scarcity of information on the description of the clinical characteristics of covid- patients in nigeria. the only available study, to the best of our knowledge, describing the clinical characteristics of covid- patients in nigeria evaluated the first covid- patients in nigeria [ ] . this study was designed to provide a larger description of the clinical characteristics of patients presenting to an isolation centre in lagos, nigeria and confirmed to be infected with sars-cov- by real time reverse transcriptase polymerase chain reaction (rt-pcr). . cc-by-nc-nd . international license it is made available under a is the author/funder, who has granted medrxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint the copyright holder for this this version posted september , . . https://doi.org/ . / . . . doi: medrxiv preprint with ethical approval obtained from the institutional review board (irb) at the nigerian institute of medical research (nimr), yaba, lagos, nigeria, patient data were obtained and reviewed at the mainland infectious disease hospital, yaba. informed consent was also obtained from the study participants before their health records were obtained. this study is a case series that includes patients that are evaluated between june and august , , and diagnosed with covid- . the idic is a central, comprehensive and integrated healthcare organization attending to covid- patients in lagos, the epicentre of the epidemic in nigeria. all the patients included in this study were confirmed to have been infected with sars-cov- by a positive reverse transcriptase polymerase chain reaction test of nasopharyngeal, throat and blood samples. clinical outcomes were also monitored and recorded. clinicians and trained research assistants reviewed patient health records retrospectively and copied them out to a standardized data collection form. health records copied out include demographic information, signs and symptoms presented with, co-morbidities, and patient outcome. a formal sample size was not calculated for this study because the objective of the study was to describe the clinical characteristics of the patients who had enough information in their health records for analysis. records were double entered into the forms before merging to reduce errors during data entry. descriptive analyses were performed using statistical package for the social science (spss) version (ibm, usa). . cc-by-nc-nd . international license it is made available under a is the author/funder, who has granted medrxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint the copyright holder for this this version posted september , . . https://doi.org/ . / . . . doi: medrxiv preprint with covid- being a novel disease, it is assumed that the immune system is naïve. hence, the definition and description of the clinical characteristics after infection with the sars-cov- is important to foster early detection and control of the spread of the disease. a total of covid- patients were included in this study. the mean age (standard deviation, [s.d]) of the study participants is . ( . ). information about travel history was not collected because a nationwide lockdown was effected on th march [ ] , and the study participants presented at the health centre between may and august, a time when community transmission of sars-cov- was already established in nigeria [ ] . hence, it was assumed that the virus was contracted from other individuals infected with the virus. nearly all of the study participants ( . %) were symptomatic (table ). this may explain why they presented at the health centre. this speaks to the health seeking behaviour of covid- patients as being largely determined by the onset of symptoms. asymptomatic patients are almost never aware that they are infected and, hence, do not need medical attention [ ] . four ( . %) out of all the patients included in this study died, giving a mortality rate of . %. all four patients that died had co-morbidities -hypertension, diabetes, lower respiratory tract infection (lrti) and pneumonia that further complicated the disease. . cc-by-nc-nd . international license it is made available under a is the author/funder, who has granted medrxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint the copyright holder for this this version posted september , . globally [ ] , the most occurring symptoms were fever, cough and malaise. . cc-by-nc-nd . international license it is made available under a is the author/funder, who has granted medrxiv a license to display the preprint in perpetuity. the copyright holder for this this version posted september , . . cc-by-nc-nd . international license it is made available under a is the author/funder, who has granted medrxiv a license to display the preprint in perpetuity. the copyright holder for this this version posted september , . . https://doi.org/ . / . . . doi: medrxiv preprint none of the patients needed ventilator-assisted breathing, developed ards, or had organ failure. the disparity between the severity of the disease in nigeria (and by extension the african continent) and the rest of the world has been discussed by other studies with some reasons given for the observed disproportionality in outcomes include the relatively young population in africa, lower rates of obesity, poor access to health care, familiarity of the continent with outbreaks of infectious diseases, impact of health disparities, and lower socioeconomic factors in africa [ ] [ ] [ ] . although, on the other hand, reports from other continents show higher morbidity and mortality in people of african heritage [ , ] . about three-quarter of the study participants were men, a trend also observed in other studies [ , ] . sars-cov and mers-cov have also been reported to infect more males than females, a phenomenon that could be attributed to protection from the x chromosome and sex hormones, known to play significant roles in innate and adaptive immunity [ , ] . other possible reasons proposed for the increased susceptibility of men to covid- include biological reasons such as a higher expression of angiotensin-converting enzyme (ace , a reception coronaviruses) in males than females; and behavioural reasons -higher levels of smoking and drinking in men, and irresponsible attitude, reviewed by [ ] the results of this study suggest that older adults are more likely to be infected with sars-cov- and be more susceptible to develop the severe disease, a trend that may be due to the reduced immunity in older adults. this trend is well established globally, reviewed by [ ] . in this study, the four patients who died were all older than years. it has also been reported that old age, obesity and the presence of co-morbidities may be associated with increased mortality [ ] . the results of this study have implications for public health, particularly the surveillance and diagnosis of sars-cov- . the clinical signs and symptoms may not be specific only to covid- , public health workers and clinicians should consider these symptoms in addition to epidemiological information such as travel history, contact with suspected or confirmed cases of covid- within days, and the presence of co-morbidities. in addition, although only ( . %) of the study participants were asymptomatic, it is known that they can be infective [ ] , and they should be identified as quickly as possible through the sampling of the contacts of each confirmed case, so that the spread of the virus can be controlled. furthermore, this study highlights the importance of the integration of different intervention measures to contain the . cc-by-nc-nd . international license it is made available under a is the author/funder, who has granted medrxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint the copyright holder for this this version posted september , . . https://doi.org/ . / . . . doi: medrxiv preprint spread of the virus -highly effective contact tracing, isolation or quarantine, social distancing, the use of hand sanitizers, wearing of masks, and washing of hands [ ] . this study has its limitations. first, the study is limited by the sample size. only patients were included in the study. suspected, but not confirmed, cases were not included in this study. more patient data from other health centres around the country should be added to obtain a more comprehensive understanding of the clinical characteristics of the disease in the country. second, patient data such as travel history was also incomplete at the time this study was conducted, hence the assumption of local transmission. however, this study presents, to the best of our knowledge, the largest report describing the clinical characteristics of covid- patients in nigeria. in conclusion, this study presents the most extensive description, to date, on the clinical and demographic characteristics of covid- patients in nigeria. from the results of this study, males are more likely to be infected with covid- , and the most occurring symptoms are fever, breathing difficulty, malaise, dry cough and chest pain. old age and the presence of comorbidities may also be associated with disease severity. • the only study from nigeria on the subject so far ( patients) reports fever and dry cough as the most common symptoms. • we present data from covid- patients, with the most common symptoms being fever, breathing difficulty, malaise, dry cough and chest pain. • males are more likely to be infected; old age and co-morbidities are associated with disease severity. this work represents an advance in biomedical science because we present the most extensive description so far on the clinical and demographic characteristics associated with covid- in nigeria. . cc-by-nc-nd . international license it is made available under a is the author/funder, who has granted medrxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint the copyright holder for this this version posted september , . . https://doi.org/ . / . . . doi: medrxiv preprint approval to conduct this study was received from the institutional review board (irb) at nimr, yaba, lagos. informed consent was obtained from the participants before they were enrolled in the study. all authors gave their consent for publishing besides those presented in the study, there are no other supporting data for this manuscript. all authors declare no competing interests. the pi and co-authors financed this study . cc-by-nc-nd . international license it is made available under a is the author/funder, who has granted medrxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint the copyright holder for this this version posted september , . . https://doi.org/ . / . . . doi: medrxiv preprint who. coronavirus disease (covid- ) situation report- of novel coronavirus-infected pneumonia diagnosis and treatment recommendations for pediatric respiratory infection caused by the novel coronavirus a familial cluster of pneumonia associated with the novel coronavirus indicating person-to-person transmission: a study of a family cluster the proximal origin of sars-cov- epidemiology of coronavirus disease (covid- epidemiological and clinical characteristics of cases of novel coronavirus pneumonia in wuhan, china: a descriptive study novel coronavirus patients' clinical characteristics, discharge rate and fatality rate of meta analysis clinical features of patients infected with novel coronavirus in wuhan treatment of covid- : old tricks for new challenges covid- nigeria clinical presentation, case management and outcomes for the first covid- patients in nigeria coronavirus lockdown: nigerians cautious as restrictions eased in lagos and abuja sars-cov- genomes from nigeria reveal community transmission, multiple virus lineages and spike protein mutation associated with higher transmission and pathogenicity. virological population-based age-stratified seroepidemiological investigation protocol for covid- virus infection clinicopathological characteristics of patients with covid- in china: a meta-analysis clinical characteristics of covid- patients: a meta-analysis africa's response to covid- the prospects for the sars-cov- pandemic in africa the lancet editorial. covid- in africa: no room for complacency covid and increased mortality in african americans: socioeconomic differences or does the renin angiotensin system also contribute increased cardiovascular mortality in african americans with covid- sexbased differences in susceptibility to severe acute respiratory syndrome coronavirus infection sexual dimorphism in innate immunity why men are more vulnerable to covid- than women why does covid- disproportionately affect older people clinical features of three avian influenza h n virus infected patients in shanghai the guideline for the diagnosis and treatment of novel coronavirus pneumonia (trial version sixth) managing covid- in low-and middle-income countries the authors wish to thank the members of staff of the nigerian institute of medical research (nimr), yaba, and the mainland infectious disease hospital, yaba, lagos. annals of health research ; ( ): - . doi: . /ahr. - - . cc-by-nc-nd . international license it is made available under a is the author/funder, who has granted medrxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprintthe copyright holder for this this version posted september , . . https://doi.org/ . / . . . doi: medrxiv preprint it is made available under a is the author/funder, who has granted medrxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprintthe copyright holder for this this version posted september , . . https://doi.org/ . / . . . doi: medrxiv preprint . cc-by-nc-nd . international license it is made available under a is the author/funder, who has granted medrxiv a license to display the preprint in perpetuity. the copyright holder for this this version posted september , . . https://doi.org/ . / . . . doi: medrxiv preprint it is made available under a is the author/funder, who has granted medrxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprintthe copyright holder for this this version posted september , . . https://doi.org/ . / . . . doi: medrxiv preprint key: cord- - wln vr authors: nwalozie, chijioke j title: exploring contemporary sea piracy in nigeria, the niger delta and the gulf of guinea date: - - journal: j transp secur doi: . /s - - -y sha: doc_id: cord_uid: wln vr piracy is a global crime which impedes the free movement of ships containing people and goods, with its attendant economic ramifications. the perpetrators are usually heavily armed, with sophisticated weapons to enable them to hijack a vessel or vessels and redirect them to their desired location for the payment of an expected ransom. this paper thematically explores contemporary piracy in the african state of nigeria, the niger delta and the gulf of guinea. nigeria is undeniably a rich country based on its economic, agricultural and population advantages, but criminal activities like piracy have been a significant disadvantage. most of the piracy activities happening in nigeria are mainly located in the niger delta region, the heart of nigeria’s oil and gas exploration. some of the unemployed youths of the region use piracy activities as a fightback against the so-called “resource control” embarked upon by the federal government of nigeria, which disadvantages them. this paper aims to explore piracy in nigeria, the niger delta region, and the gulf of guinea. the title is seemingly convoluted, by the mere fact that the niger delta belongs to nigeria; and nigeria is geographically within the coastal area of the gulf of guinea; yet, the title intends to capture vital and specific issues on piracy affecting the area in our contemporary era. nigeria is a wealthy nation because of its vast oil resources, some economic diversity, a well-educated population, and an agricultural sector, which provides % of the national gross domestic product [gdp] (african economic outlook ). nigeria's gdp grew at an average rate of % per year from to . from place in the gulf of guineaoff the coasts of nigeria, guinea, togo, benin and cameroon (imb ). in the first quarter of , the imb piracy reporting centre (prc) recorded worldwide incidents of piracy and armed robbery against ships, compared to incidents for the same period of . in total, vessels had successful boarding, which represents % of all attacks. pirates killed one person, took crew members hostage, and kidnapped a further for ransom (imb ) . drawing from the above report, the best way to qualify the dangerous coastal area of the gulf of guinea is to brand it the "centre-point" of contemporary sea piracy (see ponniah ; see also economist ). figures and buttresse that point as the map further illustrates signs of piracy hotspots. however, nigeria has the largest share of piratical operations, perhaps due to the oil there. a closer look at fig. shows that sea piracy across the globe is not as serious as before, thus suggesting that apart from the gulf of guinea, piratical activities elsewhere is somewhat under control. how long that will last, remains a question for the future. furthermore, piracy attacks in nigerian waters and the gulf of guinea, including those on energy vessels, involve cases of armed robbery at sea, with pirates boarding and robbing the ship while in port or from small speedboats or rubber zodiacs while the vessel is underway (nincic ; asi global ; essien ) . whereas contemporary maritime piracy occurs in different geographical and environmental locations, some pirates are far more violent and even employ far more sophisticated weapons in their operations than others employ. no matter where they are coming from, pirates seem to have slightly similar modus operandi and egocentric agendas because with the changing dynamics in modern technology, so it is with the changing dynamics in criminal activities such as piracy. there is an understanding that piracy, like the slave trade, may have largely disappeared in modern times or at least plummeted to levels that would not draw the attention of the international community (kontorovich ). however, this is not the case in the gulf of guinea, which is not only one of the world's top oil and gas exploration hotspots, but sadly, a new and dangerous area to shipping, especially around the nigerian littoral zone (amodu ) . piratical attacks in the gulf of guinea is a severe risk that impedes economic progress in the region, especially nigeria's shipping industry, thereby deterring prospective investors (nightingale ) the opportunity to do business. the imb ( ) report shows that % of all kidnappings at sea and % of hostage-takings took place in the gulf of guinea. moreover, in the first half of , armed pirates in these high-risk regional waters kidnapped crewmembers, and in the same period in . they hijacked two chemical tankers, and a tug involved in another attack. among the nine vessels fired upon worldwide, eight occurred off the coast of nigeria, africa's top oil producer. these attacks occurred on average nautical miles off the coastmeaning they are acts of piracy. these pirates usually arm themselves with weapons such as ak rifles and rocketpropelled grenades and therefore pose a significant threat to the crew (asi global ; see also economist ). in , nigeria witnessed actual and attempted piracy attacks, up from the previous year. in its latest report, the imb ranked nigeria again as the highest country for reported incidents, with about attacks out of reported globally (imb ). data in fig. spanning between and reveal the trajectory of actual and or even attempted piracy activities in nigeria. the bar chart in fig. presents an undulating trend in piracy activities. considering the number of reported incidents, it illustrates that nigeria is indeed a more piracy prone environment than elsewhere. in other regions, sea piracy is plummeting. the annual piracy incidents in south-east asia, between and was from to ; and to just three off somalia, which between and was the main face of global piracy (economist ). in , piratical activities created a dangerous zone in the gulf of aden, which takes care of one-fifth of global commercial shipping. at the time, the imb reported attempted attacks in the gulf of aden. the somali pirates were earning an average of almost $ m in ransom per ship, according to a charity -one earth future [oef] (economist ). in the gulf of guinea, a former pirate is quoted as saying that: "sometimes we hijack to get money and ransoms. it depends on the ship. we can even get [anything between] million naira ($ , , € , ) and million naira" (dw ) . the issue of piratical earning and spending calls for further research. as earlier illustrated in fig. , most piracy offences in the gulf of guinea occur in the nigerian coastal environment (see also economist ; essien ), especially around the niger delta (essien ; see also lhuillery ) . most pirates are born and raised in nigeria (economist ). according to bless nube, an arrested pirate, "so far we have about trained pirates across the country. and the truth is, no successful vessel hijack operation takes place in africa without the knowledge of my gang" (see usman ) . as wolf kinzel, (frigate captain and expert on maritime security in the gulf of guinea region, at the german institute for international and security affairs[swp]) suggests, since there have been a quarter fewer attacks on ships. however, there is an increase in hijackings. also, the pirates have made changes in their operational approach: instead of three seamen, they take the entire crew with themhostages for ransom (d.w. ). arguably, this display of new criminal tactic is a manifestation of the dynamics of crime and criminal behaviour. the piracy problem in nigeria ultimately links to the country's dysfunctional oil industry and the violent politics of the niger delta. given that nigeria is the world's eighth-largest producer of oil, unfortunately, it suffers from shortages of refined fuels (economist ). some see this as a problem created by some unpatriotic citizens seeking to stymie national progress and development. according to dr. christian bueger, a cardiff university researcher in the united kingdom, one of the significant causes of piracy is corruption, weak law enforcement and poverty (ben-ari ). these causes suggest that the problem with piracy in nigeria is traceable to the conspiracy with government officials. again, as bless nube reveals, "we do not work in isolation. we have a network of ministries' workers. what they do is to give us information on the location and content of the vessels to be hijacked. after furnishing us with the information, they would make part payment, and after the hijack, they would pay us the balance" (usman ) . similarly, perouse de montclos ( ), claims that some navy, customs and ports authority staff collude with the pirates by providing insider information, to unleash piracy and armed robbery on vessels navigating the high seas, in the hope to share the proceeds among the parties. a report by the imb reveals that apart from somalia, the gulf of guinea remains the second most affected region of africa; and most attacks continue to occur in nigerian waters. the year began with the capture of an oil supply vessel and a subsequent attack on a royal dutch shell tanker. on january , in one of the most worrisome attacks to date, militants from the niger delta region attacked the mt meredith, a tanker carrying tonnes of diesel fuel. they kidnapped a romanian crewmember, that was released the next day (nincic ). the militants, believed to be associated with the movement for the emancipation of the niger delta (mend), were successful in dynamiting the ship's engine and severely disabling the vessel. while the mend and other related "copycat" groups had previous histories of attacking and blowing up oil pipelines, this was the first time such an attack had occurred at sea, thus indicating an increasing concern for the future (see nincic ). the number of attacks in nigeria plummeted in when compared to attacks in (when there were reported incidents). nevertheless, the actual number may be more than twice as high, as many incidents, especially those involving fishing and oil vessels, experience the dark figure of crime (nincic ). comparatively, underreporting of piracy incidents is less problematic in south-east asia and the gulf of aden for two reasons. first, there is trust on the part of authorities in south east-asia regarding their reporting regime. second, it does not take time to report incidents that occur off somalia to international navies stationed there since (economist ). piracy has been going on for years in the gulf of guinea, but nobody fully reports the total number of occurrences by around - % (d.w. ). a significant number of attacks on ships in nigerian waters (some of which occurred over miles from shore) represent not only a geographical expansion of threats to maritime energy assets, but also perhaps an increasing oceangoing ability on the part of pirates in the area (see nincic ). as the graph in fig. suggests, since when global piracy attacks saw its lowest number of , the year has had the least attacks and attempted attacks numbering on ships (prins ) . arguably, the drop in global oil prices would have brought about a decrease in piracy activities in , but the data in fig. does not seem to suggest such. oil piracy is not the only thing pirates look for in a vessel. besides other goods, they hope to take people hostage to attract enormous ransom. however, these statistics require careful consideration for reasons ranging from data collection and collation regimes, and issues of attempted and or actual piracy and or armed robbery activities against ships on the high seas. it should be borne in mind too that the international maritime organisation [imo] tags or labels the reports by member states and or international organisations "acts of piracy and armed robbery 'allegedly' committed..." (see imo.org database). all these factors must be put into perspective when considering piracy data. piracy in nigeria has become a phenomenon which occurs at any time, and at any given opportunity, which the pirates deem fit. with mobile phone technology, pirates who are mainly male youths can get hold of their required targets. moreover, from street protests and international lobbying to sabotages and armed struggle, the politicisation of rebel and criminal groups certainly played a vital role in the development of contemporary piracy in nigeria (perouse de montclos ). it is interesting to note that all maritime pirates are virtually good or rather skilled swimmers. they are likely to come from coastal communities (perouse de montclos ), which is why piratical activities in nigeria are dominant in the south and south west of the country. according to sky news ( ), pirates kidnapped crew members of swiss ship around the niger delta littoral communities. most of the captives were foreign nationals of the philippines, slovenia, ukraine, romania, croatia and bosnia. the capture of a crew gives rise to negotiations for the payment of enormous ransom before an expectant release if the captives are still alive. some of the prevailing conditions in nigeria and the gulf of guinea are no different from the ones in somalia when piracy levels increased years ago namely: weak and corrupt governments, political violence, widespread economic hardship and easy access to weapons (see prins ) . the current decrease in piracy incidents in somalia does not mean that their internal problems are over. it does suggest that concerted efforts of international navies with proficiency in tackling sea piracy have made a significant difference. the case of somalia goes to prove a point that piracy thrives in the littoral countries because of their inability to work cohesively (economist ). although no one merely disputes reported cases of piracy activities, nevertheless, it is essential to exercise caution regarding the authenticity of such information. the reason is that different sources might have different information to give, depending on how they collected and collated their data. as the former managing director of nigerian maritime administration and safety agency (nimasa), ziakede patrick akpobolokemi, suggests, most of the reported piracy attacks on nigeria's territorial waters are untrue. they are deliberate sabotage from foreign insurance companies, otherwise called protection and indemnity clubs [pics] (rider ) . however, an undisputable issue remains -sea piracy exists in nigeria, although it might not be to the degree highlighted by the pics or it might even be more than that. nevertheless, piracy issues in nigeria require urgent attention, especially in the niger delta. relatively, the volatile pirate attacks along the gulf of guinea is seriously taking a toll on nigerian shipping activities. worse still, the inability to respond to piracy attacks is resulting in higher insurance premiums and crewing costs for shipowners who encourage them to lobby for stricter security measures (hassan ) . for those reasons, the former nimasa boss has maintained that foreign insurers are sabotaging nigeria's economy, especially in the way they report about piracy activities in the subregion (rider ) . beyond insurance rhetoric, maritime piracy in nigeria has become a "political subject" around those in the corridors of power. also, it has apparent links to marginalisation, poverty, resource control and the "cancer of corruption" endemic in the whole country (see okoronkwo et al. ). it appears the political will to deal with piracy remains tenuous. people in both public and private life face severe challenges by the effort to live with and overcome discordant tendencies across the country. the federal formation of the country is colonial and remains the present ideological and political solution (marenin and reisig ) . nigeria has failed to establish "true federalism"; instead, it has fostered the political scramble for power among different ethnic groups. since nigerian politics has become a tussle for power between ethnic groups, the issue of policies is immaterial in that tussle so much so that the country belongs to the ethnic group or groups that hold power (anyanwu ) . the political events that took place in the old western nigeria in injected into the social structure a new pattern of violence, which became the acceptable avenue to achieve political ends. it started with election malpractices, which the then federal government condoned because it belonged to the ruling party at the timethe nigeria national democratic party (nndp). in the violence that erupted, people were maimed, killed and bodies littered on the streets. this event prepared nigerians for the civil war that started in (rotimi ); a war fought for racial or ethnic injustices more than anything else (see akinwumi ) . that war is far from being over because there are still social divisions by regions, birthplace and state of origin; ethnic affiliations; religious beliefs; ideological dogmas, and class distinctions (marenin and reisig ) . internal conflicts and violence in nigeria tend to emerge at moments when groups perceive denial of access to what they consider to be their right; be they linguistic, political, economic, administrative, commercial, and religious. the most critical issue, therefore, is the perception and fear of domination by a group (ibrahim : ) . in recent times, ethnic injustices have continued to occur in different parts of the country. such may have given rise to the formation of ethnic militias. they include the oodua peoples congress (opc) in the south-west, movement for the actualisation of the sovereign state of biafra (massob) in the south-east, egbesu boys of africa (eba) in the south-south, the arewa congress (a.c.) in the north-west, north-central and north-east (oladele ) . the mission of these militias has been to seek redress for political and economic disadvantage, the decentralisation of state powers, autonomy and self-determination in the sense of resource control, the provision of security and the right to determine their future in the political landscape of nigeria (agbu : ) . some other minorities (such as those of the niger delta region) have equally formed rebel groups such as movement for the survival of ogoni people -"mosop", the niger delta people's volunteer force "ndpvf", and "mend". the niger delta remains a substantial breeding ground of youth militancy arising from high levels of poverty in the face of considerable investments in oil exploration and exploitation (mberu : ) . the picture in fig. shows the niger delta militants ready for action on the high sea, while the emergence of mend in coincided with a sharp increase in piracy activities the following year, thus revealing that mend is a significant player in maritime piracy in nigeria (charlesbois ) . both the supporters of mend and the pirates are natives of tribal communities living in the niger delta region (ikelegbe : - ) . mend, is the leading rebel group, which claims to be an "archenemy" of both the nigerian government as well as the multinational oil companies. mend faces criticism for having ties to al-qaeda, but the mend leaders deny this (nodland and odin : ) . previously, in an early study of piracy, kania ( ) , fell victim to the "ecological fallacy" in indirectly attributing nigerian piracy to muslims but this assumption was corrected (see kania and nwalozie ) . most of the piracies thrive in the niger delta -an area of defunct republic of biafra -a secessionist region of nigeria, which fought for independence between and . the majority of the people there are christians (see united nations ). many other groups are actively participating in the legitimate struggle, as they see it, for better lives. many attacks have been staged by local villagers and gangs who are annoyed with industry and corrupt government whose primary focus, it appears, has been to "fill their own pockets" (nodland and odin ) . besides, criminal mobs have exploited the deteriorating security situation purely for financial gain, at times, lending legitimacy from mend (nodland and odin ) . over time, it has become necessary to articulate the catastrophic and criminal events in the niger delta: but nigeria's oil belt, the niger delta region is embroiled in resistance against the nigerian state and the multinational oil companies. the region is generally restive, with pockets of insurrection and armed rebellion. decades of oil exploitation, environmental degradation and state neglect has created an impoverished, marginalised and exploited citizenry which after more than two decades produced a resistance of which the youth has been a vanguard. a regime of state repression and corporate violence has further generated popular and criminal violence, exploring contemporary sea piracy in nigeria, the niger delta and... lawlessness, illegal appropriations and insecurity. the niger delta is today a region of intense hostilities, violent confrontations and criminal violence. it is pervaded by a proliferation of arms and institutions and agencies of violence ranging from the nigerian armed forces to community, ethnic and youth militias, armed gangs and networks, pirates, cultists and robbers (ikelegbe : ) . it is equally challenging to establish what motivates these militant youths in the niger delta. most of them justify their actions in political terms; some of them do so convincingly as they insist on less corruption, cleaner waters and fairer revenue distribution; some do not. as things are, the nigerian oil crisis has more than its fair share of rouges whose only real motivation is banditry and opportunist crime (nodland and odin ) . both the nigerian government and the multinational oil firms feel the pain most. they are left with appalling choices to accept falling revenues and increasing security risks, as their personnel and material assets face threats by an assertive, competent, and highly motivated resistance force (nodland and odin ) . since the s, niger delta minorities have been agitating against marginalisation, neglect, and the politics of exclusion by the ethnic majority based ruling political parties, and governments of former eastern and western regions. this discrimination spiralled into the minority agitation for the creation of distinct regions, which the willinck's commission of , disallowed and to a certain extent provided constitutional guarantees in the form of fundamental rights. nevertheless, the willinck's commission granted a special developmental status in the form of a niger delta development board (nddb). the materialisation of commercial oil production from the region in and afterwards raised the stakes high and generated a struggle by the natives for control of the oil resources (ikelegbe : ) . however, in the s, the new oil economy brought about the political co-operation between the niger delta minorities (ndm) and the hausa/fulani elite. this alliance came about to foil the aggressiveness and hegemonic intentions of the yoruba and igbo neighbours over the ndm. the creation of the mid-western region and afterwards of states liberated the ndm from the direct political control of the igbo and yoruba political elite. after that, the identity struggles of the ndm directs itself towards the oil economy (ibrahim ) and its control. as discussed above, "resource control" or the issue of "patrimony" in the niger delta is probably the primary issue at stake that has generated civil unrest. also, it has taken many lives, destroyed properties and fostered criminal activities such as oil bunkering, kidnapping, armed robbery and piracy on the coast for decades. as the leader of the "ndpvf", alhaji mujahid dokubo-asari once said, "there is nothing wrong if i take the crude oil found in our land, refine it and sell to our people at ngn per litre. the real 'bunkerers' are the federal government, which has been stealing oil from ijawland since " (the guardian, october cited in ikelegbe . the niger delta region persistently calls for development, but it is disappointing that the federal government is not doing much for the benefit of the indigenous people. the radical decision of the local youths has become apparent: "if they do not benefit from the oil output, then they will stop the oil from being produced" (arnold : cited in ikelegbe : ) . therefore, when the locals see the spread of oil platforms, pumping stations, and other oil installations and infrastructure across the region, they express their displeasure by obstructing the extraction process (oyefusi ) . their overt reactions have taken different patterns over the years. they are the consequences of calculated injustice and neglect of a people whose naturally endowed resources have been the "lifeblood" of the entire nation. by decrees, oil and gas became owned by the federal government, and progressively, the region's entitlements by way of derivation based allocation declined from % to a mere . % in and later went up a bit to % in . further, the region was marginalised and neglected in the developmental efforts that followed massive oil revenues. the region by the s was one of the least developed and most impoverished. however, and regrettably too, increasing oil exploration had made the region economically and socially drained, courtesy of extensive environmental degradation and ensuing socio-economic disruptions and poverty (peel : ) . in the early s, filled with resentment over their non-participation in the benefits accruing from oil extracted from their land, a majority of niger delta youths fearlessly undertook a broad programme to disrupt oil extraction in ogoniland. furthermore, in the late s, to disrupt oil flow in ijawland, isokoland, and other ethnic groups in the area. the same group of youths were also involved in the abduction of multinational oil companies' staff, and the hijack of their helicopters and boats (ikelegbe : ) . those criminal activities were carried out in expectation of some ransom probably paid after severe negotiations between the captors and representatives of the captives. in short, a large pool of restive youths in the region [such as the ogonis, ijaws, and isokos] took advantage of the political alienation on the ground to exploit criminal opportunities available (ikelegbe ) . it could be that in their estimation, the risk they took was worth it because it made their voice heard loudly by the federal government. to pacify the people, and for the first time in nigeria's history, a federal minister of niger delta region was appointed by then-president yar'adua to provide oversight into projects and people's complaints, and above all to be the federal government's presence in the region. successive governments have followed the historic pace set by yaradua, by the appointment of a federal minister of niger delta. furthermore, the yar'adua administration, which started in , directed vast sums of money to the niger delta region; and multinational oil companies located in the region have begun to pay protection money. despite that, politicians native to the locality are still in the fight for control of such funds. in tandem, the violent protest has become part of the "political rent-seeking"-how some politicians or an elite group collect money or rather receive bribes directly from multinational oil companies for their selfish ends. such funds are illegitimate and untaxed. however, their use is to assuage such politicians who may be influential in their local communities. once the politicians are "settled financially", they can convince the rest of their community to refrain from further insurrection and allow the oil companies to continue their exploration. overtime grievance has given way to greed (see watts ) . perhaps, it is difficult to assume that the region's "burning issues" are far from over as resource control which is one of the factors responsible for maritime piracy, is still a "grey area" that requires the proper intervention of all the stakeholders. the buhari administration wants to further the development of the niger delta region. for that reason, the federal ministry of niger delta had awarded many contracts but allegedly to politicians and government officials. in the current political climate, the federal house of representatives (fhr) is investigating the federal ministry of niger delta over a corruption scandal about the award of many niger delta development commission (nddc) contracts. at the time of completing this paper, the probe by the fhr was at its earliest stages. media reports reveal that those alleged to have benefitted from the fraud include some top government officials, the ruling all progressive congress (apc) party officials and former governors. others include some members of the national assembly, a judge, senior police and army officers, some traditional rulers, and the economic and financial crime commission [efcc] officials (saharareporters ; odunsi ) . furthermore, recriminations and counter recriminations are on the horizon. a dramatic episode captured by both the national media outfits, and the social media, was the sudden fainting of acting managing director in the nddc while answering questions from members of the fhr committee on nddc. if members of the fhr do not take the fraud investigation seriously, and the perpetrators able to face justice, it might exacerbate youth restiveness, piracy and allied crimes in the niger delta. the reason being that those who should ab initio benefit from the outcomes of the contracts (niger delta communities) are still suffering from untold hardships created by the bourgeoisie. when the corruption scandal probe ends, a new bill should urgently be passed by the national assembly and assented by the president of the federal republic of nigeria, ensuring that politicians and public servants do not apply or tender for government contracts in the country. in an attempt to fight maritime piracy, the government, in august , appointed a one-time delta warlord from bayelsa state, general boyloaf, as leader of a maritime security outfit in his home state of bayelsa. it is worth remembering that boyloaf once led an aggressive attack on a shell oil platform km ( miles) offshore. according to boyloaf, "the government was having serious security challenges in the creeks. they chose me to deal with it as the creeks are my terrain. i was born in the creeks, i fought against the government in the creeks, and i will now use that knowledge to hunt the pirates" (see harper ) . with the buhari administration in office, the military have taken over the safeguarding of national pipelines with security reassurance. earlier president buhari had ordered the cleaning up of oil spillage in the niger delta. this situation had adversely affected the overall well-being of the locality, marine life, maritime transportation, and indeed the economic growth of the entire country. maritime transportation is a very crucial economic sector that under-props not only international trade but also enhances global economic integration and globalisation (igbokwe ) . the reason is that % of global trade moves via marine vessels (essien ; gosalbo-bone and boelaert ) . this marine transportation represents around , merchant vessels, . million seafarers and almost six billion tonnes of cargo annually (essien ) . besides, nigeria being a coastal and an import-oriented state depends mostly on international shipping for revenue from the mining of natural resources, primarily crude oil, and of course, not excluding the movement of essential goods to and from other countries (igbokwe ) . that is to say; maritime transport is necessary for the stability of nigeria's economy. moreover, the gulf of guinea remains a critical maritime route for international shipping from europe to america, to west, central and southern africa. the region's importance in the global energy supply is evident due to its proximity to europe and north america for the transportation of crude oil and gas from the region (igbokwe ) . at least % of europe's oil and gas comes from the gulf of guinea (d.w ). therefore, the gulf of guinea is considered a strategic location due to its natural resources. besides, piracy has had negative impacts on global trade and the growth of the global economy (igbokwe ) . contemporary maritime piracy has become a pressing issue which costs the global economy $ . billion in a year (knorr ) . on the domestic arena, piratical activities on the nigerian waters have resulted in economic sabotage that is already affecting the country's image at the international scene and impeding national development (hassan ) . estimate revels that nigeria loses , barrels of crude oil every day to oil thieves, which amounts to about n . billion daily, and over n billion annually (amodu ), thus alluding to a corrupt society and a corrupt economy. although this data may not represent the full scale of the losses, depending on where and how information is coming from; at least it tries to cast a shadow on the severe economic problem facing nigeria, which partly arises from piracy. also, the coronavirus disease "covid " pandemic has adversely affected individuals, countries and indeed the global economy. shipping of goods is affected, and global piracy activities are gradually picking up beyond last year's figures (see prins ) . now, the rate of covid infection in nigeria is minimal compared to western societies, india and some latin american countries like brazil. with the struggling nature of policing piracy activities in the gulf of guinea and elsewhere, if there is a more significant increase in the rate of covid infections and deaths, governments' attention may withdraw entirely from piracy issues to focus on covid . when that happens, opportunist pirates might cash in on that to hijack the vulnerable vessels that fall prey to them (see prins ) . since what affects nigeria affects the gulf of guinea; governments in the region, and especially nigeria must be up to speed in ensuring against the threat to economic activities as a result of maritime piracy, hence the need for high-level security operatives that patrol the waters. the fight against piracy is a high-security challenge for the nigerian navy. besides the joint global efforts to tackle piracy through maritime patrol, the nigerian navy had in january installed at least, eight automated camera-equipped surveillance towers in the littoral zone just off the nigerian coast (oseghale ) . before that, on august , the federal government established the nimasa by merging the national maritime authority (nma) with the joint maritime labour industrial council (jmlic), both former parastatals of the federal ministry of transport (amodu ). as the former director-general of nimasa, mr. ziakede akpobolokemi had said: since its establishment, nimasa has strived to live up to its 'mission statement': "to achieve safe, secure shipping, cleaner oceans and enhance maritime capacity in line with best global practices towards nigeria's economic development" (amodu ). akpobolokemi's management of the agency recorded quite some successes in the fight against oil thieves and other criminals on nigerian waters by arresting, seizing and detaining many found to have breached any of the provisions of the nimasa, cabotage and the merchant shipping acts (amodu ). these successes have been possible because the agency's team have been working with the nigerian navy and the nigerian air force, which used sea and air patrols surveillance, respectively. they quickly put up a response and reception plan, which led to the hijackers abandoning their mission and fleeing (amodu ). according to akpobolokemi, the new hour surveillance centre is capable of detecting boats, ships, and objects of predefined cross-section floating on water, which includes any aircraft that ditches and remains on the surface during satellite over-flight. its abilities further include, but not limited to setting range rings and restricted areas for which when penetrated by an intruder, the system gives an alarm thereby alerting the operator and watch-keeper (amodu ). this signal will then make it clear to security operatives to react to a possible attack on a maritime vessel offshore. the former nimasa boss argues that bringing an end to piracy, armed robbery and kidnapping on the nation's territorial waterways is a non-negotiable venture. the agency have taken proactive initiatives ahead of pirates within the areas and with a promise to continue to frustrate kidnappers in their evil acts (hassan ) . similarly, the former flag officer commanding (foc) eastern naval command, rear admiral charles obiora-medani, stressed that the rate of criminal activities perpetrated by sea pirates along the waterways in cross river and akwa ibom states had reduced drastically. the former foc pointed out that the drastic drop in oil theft and other criminal acts within the waterways is consequent upon the regular and active naval patrol along the calabar-oron and ikang waterways. such action has made it difficult for sea robbers to attack oil service vessels and international boats that apply between nigeria, sao tome, cameroun and gabon. however, pirates have now changed course to attacking soft targets which are passenger boats (hassan ) . arguably, if a new procedure is put in place to control or deter criminals, they (criminals) will, in turn, redesign their escape routes to perpetuate their criminal operations. to further help combat piracy on the nigerian waters, the federal government bought four patrol ships -nns centenary, nns prosperity, nns okpabana and nns sagbama, and handed over to the nigerian navy for use in their operations. despite the launched ships, the criminal activities of pirates are still thriving along the nigerian coasts (hassan ) . back in the old days, in , a small nigerian naval force was established with ten small vessels, adequate only for coastal security functions. it acquired a corvette in , and two more were added in . the soviet union supplied several motor patrol boats in the late s, providing nigeria with the necessary resources to combat any pirate crew in her territorial waters (nigerian navy ). however, much of the nigerian navy still consists of older ships; some transferred to nigeria from great britain upon her independence in . many of these were world war ii surplus. maintaining such an ageing fleet has been a significant burden on nigerian navy resources (nigerian navy ) . recently, in , the nigerian navy acquired vessels ( small boats and patrol vessels) to help protect the maritime environment, including the oil and gas infrastructure (defenceweb ). probably, this project aims at having up to date state of the art equipment that can weaken and surmount the nefarious activities of sea pirates, which affect both national and global economies. figure above shows one of the new patrol boats (p ) with the name: nigerian navy ship "nns nguru", after its commissioning. it is a -metre vessel designed to be equipped with two . mm and one mm cannon (defenceweb, ) to prevent and fight piracy and allied criminal activities on the littoral space of nigeria. although all of the west african states are trying to strengthen their coast guards with western help, and there are ongoing efforts to share information on shipping and attacks; however, if there is to be a lasting solution to piracy, nigeria will have to take the lead in regularly patrolling its waters and restraining illegal activity (the economist ) because according to an arrested piracy suspect, bless nube: the code name for piracy is 'coja', and it is very lucrative just as it is dangerous because one may be confronted by security agents in the process, or even get arrested as i am now. but it will be difficult for the president to win the war. if he must win, then he has to look inward. lagos state, for instance, is a major coastal place where we meet to discuss on our next target. so, government must first search its big men if it is serious in winning the war (usman ). the above quotation implies that some unpatriotic political office holders in nigeria are complicit in piracy activities. it is utterly disappointing that government officials who should be role models to youths end up conniving with them in crime, thereby scandalising them and approving criminal behaviour as the objective norm. when things like that happen, it becomes challenging to combat sea piracy. at times, pirates can defeat the navy in the gun battle. for example, armed pirates raided the oil dredger mv ambika as it worked in the dangerous waterways of the niger delta late on thursday january . during the incident, a team of naval rescue squad came on a rescue mission, but during the gun battle, the pirates succeeded in killing four of the naval personnel of the squad. before the arrival of the naval rescue team, the pirates had gained access into the vessel and abducted two russians and one indian who were part of the eight crew members onboard the vessel (agence france-presse ). an occasion of this nature raises questions about what went wrong on the navy's side regarding professionalism and the use of resources. also, it calls for a thorough investigation regarding what made pirates win the battle, in the hope that it does not happen again. on june , president muhammadu buhari signed into law a bill of the national assembly, now called the "suppression of piracy and other maritime offences (spomo) act ". the spomo act recognises the relevance of the united nations convention on the law of the sea [unclos] , and the unlawful acts against the safety of maritime navigation [sua] and its protocols. interestingly, there is a replication of the unclos definition of piracy in the spomo act . the act appears to be the first of its kind in west and central africa, with some clarity in the fight against piracy offences (foyeku ) . however, the spomo act is a "stand-alone" but falls short of linking piracy in tandem with other transnational organised crimes (ogbonnaya ) . that gap in the law might allow pirates to abuse the system by committing other crimes alongside piracy which the act does not cover. that aside, the spomo act is a milestone in nigeria's lofty ambition to tackle maritime piracy. it is also a wake-up call for other countries within the gulf of guinea to enact similar domestic laws, and then aim at partnering at the regional level in creating a transnational legal instrument that will stem the activities of sea pirates in the region. there is no doubt that a closer and regular co-operation among navies within the region will drastically reduce the menace of the pirates. in , the west african navies did a coordinated job to recapture the hijacked m/t maximus successfully, but much of that co-operation was ad hoc. there was no formal mechanism in place at the time, but the navies did what they did as a result of relationships as neighbouring countries (ralby ) . most recently, the nigerian navy rescued both the hostages and the chinese fishing trawler hailufeng , licensed to fish in côte d'ivoire, and safely escorted them to lagos. the vessel was hijacked by pirates on thursday, may in the ivorian exclusive economic zone with crewmembers aboardeight chinese, seven ghanaian and three ivorian nationals. the tracking of the vessel became possible through a coordinated effort of several african states and organisations such as nimasa. however, the nigerian navy was able to interdict the chinese fishing vessel nautical miles south of the lagos fairway buoy at about : hours local time on the night of may . when accosted, the pirates were hesitant to stop, but the nigerian navy's special boat service embarked on the nns nguru, carried out an opposed boarding while underway at knots (ralby ). very soon, the arrested pirates will be the first to be prosecuted under the new spomo act (babalola ) . the outcome of the trial will go a long way to sending a clear message to sea pirates that their criminal activities on the nigerian littoral area will no longer be business as usual. already the nigerian navy had warned piracy perpetrators to desist from criminal activities within the gulf of guinea coastline (babalola ) . now, with the support of the new legislation, pirates can be arrested by the navy and then arraigned in court for prosecution. the security operatives and indeed, the criminal justice agencies owe nigerians the patriotic duty to ensure that corruption does not stand in the way of justice for the country, the victims and even the pirates themselves. nonetheless, the novel collaboration of the nigerian navy and nimasa has indeed paid off. now there is intelligence sharing between nimasa's command, control, communication, computers, and intelligence centre [c i] of the deep blue project, which had been in operation every day since last year. also, there is the navy's "falcon eye" that tracks pirates in operation (foyeku ) . recently, the imo secretary-general, kitack lim praised the new director-general of nimasa bashir jamoh, for his bold and dynamic approach to maritime security (global ). jamoh's determination to achieve a robust maritime industry for nigeria anchors on three main areas, namely, maritime security, safety, and shipping development (abiodun ) . with these new initiatives, piratical activities are easily detectable, and the perpetrators can be arrested and prosecuted. all the control and preventive measures against piracy have become necessary due to the nature of contemporary piracy so that nigeria and indeed, the gulf of guinea will become safe for maritime transportation. piracy in the gulf of guinea, and in particular nigeria has had a protracted history. it is traceable down to the trans-atlantic slave trade era, even though the slave trade predates it. in the past few years, piracy seems to have had an impressive decline in some parts of the world. however, it appears to have hiked in the gulf of guinea, and with particular reference to nigeria, which is concerning to the maritime environment and world community. as noted before, the scale of the problem appears to have suffered colossal neglect; hence not many nigerians seem to be aware of it. the figures may vary regarding the magnitude of attacks, depending on the data source, which explains why foreign insurers should be circumspect about labelling nigeria as a critical piracy area that is very risky for the navigation of maritime vessels. in attempting to solve the problem of piracy in nigeria, it is primordial to address the cancer of corruption, poverty, and youth unemployment. the federal government and the national assembly have a crucial role to play here by being transparent and accountable to the nigerian public. the current and yet unfolding nddc contracts' fraud indicting federal government officials and some members of the national assembly is not only scandalous; however, it undermines all the federal government's developmental initiatives in the niger delta region. to avoid future corruption scandals like this, the national assembly should urgently enact new legislation that prohibits politicians and public servants from directly or indirectly tendering for government contracts. most importantly, social amenities and job creation should be a priority for the government in combating piracy. piracy in the nigerian waters both increases and decreases, yet available data reveal that it remains a severe problem in nigeria. most of that piracy have links to oil extraction in the niger delta region; hence pirates sailing from local riverine communities seize oil tankers and hold them in hope for ransom. their claim on the abundant mineral resources of their region finds some basis upon complaints that the federal government is taking the wealth of the area and not sharing it equitably with the local population. a "pop-marxist" ideology has developed among these communities, and their actions aim at redressing this perceived inequity. the nigerian navy have shown their military prowess in fighting piracy within the niger delta and indeed the gulf of guinea. with a few examples mentioned above, they have successfully foiled piracy activities, arrested the culprits and released the hostages. effective combating of the criminal operations of pirates requires the ongoing teamwork with nimasa and committed regional security apparatuses so that the gulf of guinea can become less dangerous for navigation of vessels carrying goods and people. there are few occasions when pirates overpower the navy, leading to fatalities. such occasions should call for thorough investigation so that they do not reoccur. nigerian piracy is related to control over the abundant oil resources of the country. while nigeria is rich in resources, economically, much of it suffers from poverty and backwardness. its oil and mineral resources are not its own, but the multinational corporations are controlling them. its political institutions were modelled on those of the british colonial authorities but have evolved after the civil war and internal ethnic strife. governmental corruption is notorious so that the poor receive little from the wealth that surrounds them. its pirates are focused on attacking the ships serving the corporations exploiting her natural wealth (lhuillery ) . the nigerian pirates and delta region insurgents do not originate from the islamic factions of the country, and indeed manyif not mostpirates are not muslims. they all are products of a radicalised nigerian political environment in which mend and other groups find support and comfort from some radical jihadists (nodland and odin : ) as well as other factions. nevertheless, mend concepts seem to be "folk-marxist", and they are not a jihadist-clone organisation. instead of radical islam, most nigerian pirates find a rationalisation for their activities in the form of popular marxism and a desire for ethnic or tribal independence. they see themselves as exploited by the multinational oil companies, such as royal dutch shell. again, they feel that they are not receiving a fair share of the enormous oil wealth being taken from under their lands by the federal government and the expatriate multinational corporations. as noted earlier, nigerian piracy is most prevalent in the waters of the niger delta and the adjacent atlantic ocean. facing massive economic losses from piracy, the federal government have stepped up their anti-piracy activities (akinsanmi ) . one dramatic step is again, the enactment of the spomo act , which the judiciary will seek recourse to, for the first to prosecute the immediate arrestees. the outcome of the prosecution will hopefully, generally, deter future pirates from attempting to operate on the nigerian waters. nevertheless, combating contemporary piracy is a national and transnational project for all the stakeholders to work in unison, to ensure the safe navigation of vessels carrying people and goods within the nigerian littoral environment and the gulf of guinea. to do so, it will help boost economic development in the region. nigeria: winning war against pirates african economic outlook ethnic militias and the threat to democracy in post-transition nigeria pirates' kill nigerian navy personnel nigeria: national loses n bn to piracy, sea robberies youth participation in violence in nigeria since the s asi global ( ) maritime response. asi global response anti-piracy: as nimasa triumphs against pirates piracy in west africa: a bumpy road to maritime security pirate economics: 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stays? rural out-migration in nigerian history of the nigerian navy. nigerian navy official website piracy problem is a threat to nigeria's maritime economy phpoption=com_content&view=article&id= :maritime-piracy-implications-formaritime-energy security&catid= :issuecontent&itemid= bergen exploring contemporary sea piracy in nigeria, the niger delta and nddc: judge, ex-govs, apc chiefs, security officials allegedly got commission's contracts maritime: is nigeria's new anti-piracy law enough to combat maritime piracy? nigeria: structural constraints to socio-economic development in nigeria national security and maritime piracy in nigeria: a sociological discourse security agencies move against sea pirates propensity to civil disobedience and the probability of an armed struggle in the niger delta region of nigeria crisis in the niger delta: how failures of transparency and accountability are destroying the region. london the day the pirates came global sea piracy ticks upward, and the 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- lxy qrq authors: bolarinwa, obasanjo a.; olagunju, olalekan s.; olaniyan, akintayo t. title: factors associated with low contraceptive use amongst vulnerable mothers in south west state, nigeria date: - - journal: afr j prim health care fam med doi: . /phcfm.v i . sha: doc_id: cord_uid: lxy qrq background: young mothers tend to be more prone to high maternal and perinatal risks and are thus deemed vulnerable to adverse sexual and reproductive health rights (srhr) in terms of their right to choose contraceptives of their choice to enhance their maternal well-being and childbirth spacing should be well discussed. achieving sufficient srhr may be averted if the use of family planning by disadvantaged groups is not given required attention. aim: this study aimed to identify and analyse the factors associated with the low use of contraceptives amongst vulnerable women in the south west region in nigeria. setting: the study area was purposively chosen to capture contraceptive use amongst vulnerable women in osun state, nigeria. methods: a primary data collection was done in three senatorial districts of osun state, nigeria, with respondents each to give a total of respondents. collected data were analysed using univariate, bivariate and multivariate measures. results: the result showed a magnitude of association and relationship at both levels of analyses. living arrangements and family types were % and . %, respectively, associated with family planning use. in the same vein, living arrangement and family types were also statistically significant at p < . with an odds ratio of . ( % ci: . – . ) and an odds ratio of . ( % ci: . – . ) with family planning use, respectively. conclusion: we concluded that policies and interventions to accelerate and encourage contraceptives use amongst vulnerable mothers in south west, nigeria should be targeted at those whose husbands lived elsewhere and those whose husbands have more than one wife. an estimate of more than million women in the developing world were unable to access and use family planning or contraception (fp/c); this is also the cause of high fertility levels in african countries where nigeria is not excluded with a total fertility rate (tfr) of . per woman, and the annual population growth rate is . % with an estimated population of million. , , it is agreed that the increased spending on family planning has a compelling long-term interest in increasing human resources and family happiness. in order to reap the dividend from these investments and meet the third goal of the sustainable development goals (sdgs), the disadvantaged groups that are key to nigeria's population growth must be recognised. young mothers seem to be more exposed to high maternal and perinatal risks and are seen as being vulnerable. therefore, their sexual and reproductive health right (srhr) in terms of their right to the choice of contraception should be well addressed to improve their maternal and child health outcomes. it was also noted that most births in sub-saharan african countries take place in the union, and most of such deliveries are mistimed or unintended. this is more prominent in eastern & western africa where the unmet need for family planning is the highest. , , , , reduction in the non-use of contraceptives has a uniquely wide range of demographic, economic and environmental benefits, in addition to its well-documented health advantages for women and children, and this is because of its direct link to family sizes and population change. background: young mothers tend to be more prone to high maternal and perinatal risks and are thus deemed vulnerable to adverse sexual and reproductive health rights (srhr) in terms of their right to choose contraceptives of their choice to enhance their maternal well-being and childbirth spacing should be well discussed. achieving sufficient srhr may be averted if the use of family planning by disadvantaged groups is not given required attention. aim: this study aimed to identify and analyse the factors associated with the low use of contraceptives amongst vulnerable women in the south west region in nigeria. the study area was purposively chosen to capture contraceptive use amongst vulnerable women in osun state, nigeria. a primary data collection was done in three senatorial districts of osun state, nigeria, with respondents each to give a total of respondents. collected data were analysed using univariate, bivariate and multivariate measures. the result showed a magnitude of association and relationship at both levels of analyses. living arrangements and family types were % and . %, respectively, associated with family planning use. in the same vein, living arrangement and family types were also statistically significant at p < . with an odds ratio of . ( % ci: . - . ) and an odds ratio of . ( % ci: . - . ) with family planning use, respectively. we concluded that policies and interventions to accelerate and encourage contraceptives use amongst vulnerable mothers in south west, nigeria should be targeted at those whose husbands lived elsewhere and those whose husbands have more than one wife. keywords: family type; living arrangement; family planning; vulnerable; south west; nigeria. read online: scan this qr code with your smart phone or mobile device to read online. previous studies have noted that increasing contraceptive use in countries with high fertility rates has the potential of averting about % of all maternal deaths and % of childhood deaths. considering nigeria's maternal rate of per livebirths and child mortality rates of approximately per children, surviving up to months of age is particularly high compared with other regions that are economically developed or are on the path of economic development. this large variability of non-use of family planning is higher amongst young mothers in the south west region with an average unmet need for contraception at % compared with other regions regions with much lower unmet need for contraception, hence the young mothers could delay the progress of the country in harnessing or reaping its demographic dividend and adequate family planning use has full capacities of averting the high rate of maternal and child mortality. families can be classified on the basis of several dimensions; for example, on the basis of marriage type, families can be monogamous or polygamous which is also valid based on other classifications. it is estimated that about million couples, mainly in third world countries, do not use effective contraceptives, despite their desire to limit or space the birth of their children, with % of nigerian couples having unmet needs for contraceptives despite being sexually active. this has a lot to do with cultural and societal values the family accepts. in varying degrees, polygamy seems to be the norm in most african societies, with some % - % of women living in polygamous family settings. , there is also evidence of a close relationship between health, well-being and living arrangements. literature also argued the assertions that the decision-making on contraception comes within the domain of women but this rather depends on the type of union or how the living arrangement is structured. , despite significant global resources and investments that are being directed to nigeria to meet the current demand for family planning services, the level of contraceptive use amongst married or in-union women is lower compared with other developing countries. the gaps in attaining adequate sexual and reproductive health may be delayed if family planning use is not encouraged amongst vulnerable groups. hence, there are critical needs to examine the family type, living arrangement and contraceptive use amongst vulnerable mothers in south west, nigeria. this study aimed to identify and analyse the factors associated with the low use of contraceptives amongst vulnerable women in the south west region in nigeria. the study was quantitative research, which employed a cross-sectional descriptive survey design to elicit information on family planning use, family types and living arrangements amongst vulnerable mothers in osun state, nigeria using a structured questionnaire. osun state is an inland state in south-western nigeria. its capital is osogbo. it is bounded in the north by kwara state. the state enjoys a tropical climate characterised by two seasons: rainy season (march to october) and dry season (november to march). the study population comprised young mothers within the reproductive age of - years who already had a child in the last year. the study area was purposively chosen to capture contraceptives use and associated factors amongst this group. the data collection was done in three senatorial districts of osun state, nigeria. yamane's formula for estimating sample size was used to estimate sample size for this study, and the arrived estimated sample size was , including a % margin of error or non-response. respondents were interviewed in each senatorial district using a structured questionnaire and a multi-stage sampling procedure to give respondents altogether. the analysis was performed with stata software. the data were analysed adopting univariate, bivariate and multivariate measures. univariate analysis was used for the frequency distribution of selected socio-economic and demographic variables that are related to this study in the dataset displayed. a chi-square test and logistic regression analysis were employed to show an association, relationship and predict the likelihood between the independent variables, which are family type and living arrangement on the dependent variable, which is family planning use. the researcher ensured that the informed consent of the respondents was sought by explaining the purpose of the study; anonymity was maintained by not including their names, and confidentiality was assured. before administering the questionnaire, a copy of the research protocol was submitted for a full review to the research and ethics committee of institute of public health, obafemi awolowo university, ile-ife (iph, oau) and approval for this study was obtained with iphoau/ / . in contrast, the respondent's husbands socio-demographic characteristics show that majority of them were between ages and years with the mean age of years. the majority of the respondent's husbands have more than primary education (secondary . % and post-secondary . %). more than half of the respondent's husbands have their religion as christianity ( . %). almost all the respondent's husbands were employed ( . %). table presents the bivariate association and logistic relationship between living arrangement, family type and family planning used amongst women who already had a child in the last year. the result above showed a significant association between living arrangement and use of family planning in that % of women who were living with their husband and . % of women whose husbands were living elsewhere were using family planning. with regard to family type, the table shows that . % of women whose husbands had only one wife and . % of women whose husbands had more than one wife were using family planning. the table also reveals that there is a significant association between the use of family planning, living arrangements and family type as p < . . logistics regression analysis was carried out to assess the net effect of living arrangements and family type on the use of family planning. table also shows that women whose husbands live elsewhere are . less likely to use family planning with ( % ci: . - . ); in the same vein, women whose husbands had more than one wife were also . less likely to use family planning with ( % ci: . - . ). both living arrangements and family type were statistically significant in the study at p < . . this study also revealed that family type and the living arrangement were significantly associated with the use of family planning. the research shows that women whose husbands have more than one wife were less likely to use family planning compared with women whose husbands had only one wife. this may be due to marital conflict amongst wives with regard to the birth order or sex preference. also, women whose husbands were living elsewhere were less likely to use any method of family planning. this may be because women were not exposed to frequent sexual intercourse compared with women who were living with their husbands. the need to subscribe to contraceptives use amongst vulnerable young mothers who lived away from their husbands and who are in the polygamous union might not be there because of their infrequent sexual activities as the husbands are often not available. this study unveiled this peculiar group of non-family planning users to help scale up the adoption in south west state, nigeria. although the prevalence level of contraceptive use amongst sexually active men and women is low in nigeria, , , we studied variations by living arrangements and family types in the use of any family planning method amongst young mothers. the use of any family planning methods was high amongst young mothers living with their husbands and whose husbands have one wife. the family type was significantly associated with the use of family planning. women whose husbands were living elsewhere were less likely to use a method of family planning. also, the living arrangement was significantly associated with the use of family planning. young mothers whose husbands have more than one wife were less likely to use family planning. adoption of a family planning practice campaign that considers living arrangements and family types will further scale up contraceptive use amongst young women. , male partner influence on family planning and contraceptive use: perspectives from community members and healthcare providers in couple based family planning education: changes in male involvement and contraceptive use among married couples in jimma zone determinants of contraceptive use in oman transforming our world: the agenda for sustainable development factors responsible for teenage pregnancy and its implication on adolescent health and education: perception of secondary school students in nigeria contraceptive choice amongst women in warri, nigeria examining the role of couples' characteristics in contraceptive use in nigeria and zambia assessment of contraceptive use by marriage type among sexually active men in nigeria women's marital status, contraceptive use, and unmet need in sub-saharan africa, latin america, and the caribbean unmet need for family planning: past achievements and remaining challenges unmet need for family planning: implication for under-five mortality in nigeria differential pattern in child mortality rate in rural nigeria the family and family structure classification redefined for the current times family type, domestic violence and underfive mortality in nigeria care needs and caregivers: associations and effects of living arrangements on caregiving to older adults in india the relationship between living arrangements and higher use of hospital care at middle and older ages: to what extent do observed and unobserved individual characteristics explain this association? factors related to married or cohabiting women's decision to use modern contraceptive methods in mahikeng, south africa sub-national levels and trends in contraceptive prevalence, unmet need, and demand for family planning in nigeria with survey uncertainty measurement annex descriptive study of the role of household type and household composition on women's reproductive health outcomes in urban uttar pradesh, india. reprod health fact sheet peod- , a series of the program evaluation and organizational development, florida cooperative extension service we acknowledged partial article publication charges (apc) granted by aosis publisher. the views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of any affiliated agency of the authors. the authors have declared that no competing interests exist. all authors contributed equally to this work. this research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. de-identified dataset will be made available upon request but one of the authors must be a part of the team to work on the dataset. key: cord- -lrk ty authors: mohammed, abdulaziz; sheikh, taiwo lateef; gidado, saheed; poggensee, gabriele; nguku, patrick; olayinka, adebola; ohuabunwo, chima; waziri, ndadilnasiya; shuaib, faisal; adeyemi, joseph; uzoma, ogbonna; ahmed, abubakar; doherty, funmi; nyanti, sarah beysolow; nzuki, charles kyalo; nasidi, abdulsalami; oyemakinde, akin; oguntimehin, olukayode; abdus-salam, ismail adeshina; obiako, reginald o. title: an evaluation of psychological distress and social support of survivors and contacts of ebola virus disease infection and their relatives in lagos, nigeria: a cross sectional study − date: - - journal: bmc public health doi: . /s - - - sha: doc_id: cord_uid: lrk ty background: by september , an outbreak of ebola viral disease (evd) in west african countries of guinea, liberia, sierra leone, senegal and nigeria, had recorded over and probable or confirmed cases and deaths respectively. evd, an emerging infectious disease, can create fear and panic among patients, contacts and relatives, which could be a risk factor for psychological distress. psychological distress among this subgroup could have public health implication for control of evd, because of potential effects on patient management and contact tracing. we determined the prevalence, pattern and factors associated with psychological distress among survivors and contacts of evd and their relatives. methods: in a descriptive cross sectional study, we used general health questionnaire to assess psychological distress and oslo social support scale to assess social support among participants who survived evd, listed as evd contacts or their relatives at ebola emergency operation center in lagos, nigeria. factors associated with psychological distress were determined using chi square/odds ratio and adjusted odds ratio. results: the mean age and standard deviation of participants was +/ - . years. of participants, ( . %) were females, ( . %) had a tertiary education and ( . %) were health workers. most frequently occurring psychological distress were inability to concentrate ( . %) and loss of sleep over worry ( . %). losing a relation to evd outbreak (or = . , % ci, . – . ) was significantly associated with feeling unhappy or depressed while being a health worker was protective (or = . , % ci, . – . ). adjusted odds ratio (aor) showed losing a relation (aor = . , % ci, . – . ) was a predictor of “feeling unhappy or depressed”, loss of a relation (aor = . , % ci, . – . ) was a predictor of inability to concentrate. conclusions: survivors and contacts of evd and their relations develop psychological distress. development of psychological distress could be predicted by loss of family member. it is recommended that psychiatrists and other mental health specialists be part of case management teams. the clinical teams managing evd patients should be trained on recognition of common psychological distress among patients. a mental health specialist should review contacts being monitored for evd for psychological distress or disorders. the west african outbreak of ebola virus disease (evd) began in guinea in december [ ] . the outbreak involved sustained transmission in guinea, liberia, and sierra leone [ ] . by september , , the total number of probable and confirmed cases was , with deaths recorded from five countries in west africa namely, guinea, liberia, nigeria, senegal, and sierra leone [ ] . the first known case of evd was reported in nigeria on th july , through a man who travelled to lagos, nigeria, via lomé, togo and accra, ghana [ ] . as of th september , the total number of confirmed evd cases in nigeria was ( in lagos and in port harcourt) of which had survived and seven reported dead. four hundred and seventy contacts had completed days of follow up necessary to rule out evd infection. the news of evd spread into nigeria created widespread media attention, which initially focused mainly on the high infectivity and case fatality, with the potential to create fear and panic. also, the process of infection control and prevention necessary for the control of emerging infectious disease (eid) like evd involves the use of personal protective equipment, quarantine, and isolation [ ] , all of which may be associated with fear and anxiety. public apprehension of newly detected emerging infectious disease with high morbidity and mortality had been previously described. joffe et al. [ ] described pattern of public response to emerging infectious diseases like evd. this general public response pattern includes distancing the disease from self, blame of particular entities for the disease's origin and/or spread, and stigmatization of those who have contracted it and/or who are represented as having intensified its spread. the process may be driven by worry, fear and anxiety, which necessitate a psychosocial intervention as part of all outbreak response to eids like evd. in a study to assess the psychological impact of the outbreak of severe acute respiratory syndrome on hospital employees, about % of the respondents had experienced high levels of post-traumatic stress symptoms [ ] . researches conducted during evd outbreaks tend to focus on clinical manifestations and epidemiology of evd with little or no study on psychosocial impact or distress associated with evd. a study in democratic republic of congo described the feelings and experiences of survivors of ebola epidemic [ ] . they described psychosocial consequences among survivors to include fear of falling seriously ill, denial, fear of being accused by neighbors and shame. others included rejection by society, belief that the infection was a divine punishment, lack of income, and intense grief for colleagues who did not survive the epidemic. the previous study did not include use of a standardized instrument for evaluation of psychological distress and social support available to the respondents. no previous study that employed the use of standardized instruments like ghq or oss to measure psychological distress or social support among survivors and contacts of evd or their relatives was found after a literature review. we set out to determine the prevalence and pattern of psychological distress among the survivors, relatives and contacts of evd. we also assessed the social support available for the survivors, relatives and contacts of evd. finally, we determined factors associated with psychological distress. the study was conducted in lagos state. lagos state is located in the southwestern part of nigeria and has an estimated land area of km ( sq ml). the metropolitan area consists of islands, such as lagos island and extension into the adjacent mainland. the lagos international airport is the busiest of all the international airports in nigeria [ ] . we conducted a descriptive cross sectional study. the study population consisted of persons listed as survivors and contacts by the emergency operations center (eoc) for evd in lagos and a first-degree relation judged to be the primary care giver by the evd patient or contact. inclusion criteria survivors . persons confirmed as a case of evd in the present outbreak response and had been managed in the isolation ward of the response. . persons confirmed cured and discharged from isolation ward by case management team. persons determined by the contact tracing team to have been a contact of a known confirmed case of evd using standard protocol [ ] . . contacts who are being actively followed up or had completed the follow up period. . must be a first-degree relation (father, mother, spouse, child or sibling) who was adjudged to have actively supported the survivor during case management or contacts during contact tracing. . not currently living in lagos. we estimated that by interviewing a third of survivors and contacts in the line list of the contact tracing team as at the time of the evaluation and their relatives, we will be able to achieve the minimum sample size of calculated using the leslie and kish formula [ ] for estimating sample size for cross-sectional study. where: n = minimum sample size zα set at % significant level = . p = estimates of proportion of study population with psychological distress. we used the prevalence of % ( . ) psychological consequences of severe acute respiratory syndrome (similar eid to evd) among hospital workers in china. the calculated sample size was . the calculated sample size was adjusted for small population size (n = ) using the formula for finite population correction. where: n f = the desired sample size when population is less than , n = the desired sample size when the population is more than , n = the estimate of the evd survivors and contact or their relations ( ) as at the time of study for this study we targeted respondents we randomly selected the contacts for the study using the contact tracing team line list of all contacts with over people listed during the duration of the study. of the eight cases listed as survivors during the time of study, four were interviewed during the study period. for every contact or survivor selected for the study, we attempted to interview a first-degree relation (spouse, parent, child or full sibling) identified by the survivor/contact, if available and also meeting the case definition for a relation. we designed a socio-demographic questionnaire to collect information on the respondents' age, gender, marital status, local government area (lga) of residence, and level of education. we also asked if respondents had loss a relation due to the evd outbreak. the general health questionnaire -item version (ghq ) was used to assess psychological distress among the study participants. the general health questionnaire (ghq) is a screening questionnaire, designed for screening individuals with a diagnosable psychiatric disorder [ ] . the ghq does not generate specific psychiatric diagnosis but rather screens for individuals with possible disorders. in its original version, it had items (ghq- ), which were reduced to (ghq- ), and items (ghq- ) [ ] . the -item general health questionnaire (ghq- ) is the most extensively used screening instrument for common mental disorders in addition to being a more general measure of psychological wellbeing. the psychometric properties of ghq have been evaluated in several studies [ , ] . the oslo social support scale (oss) was used to assess patients' social support base during the period. the oslo -item social support scale provides a brief measure of social functioning and has been considered a good predictor of mental health [ ] . it covers different fields of social support, as it measures the number of people the respondent feels close to, the interest and concern shown by others, and ease of obtaining practical help. the oslo social support scale had been validated in nigeria [ ] . respondents who answered "difficult" or "very difficult" to the question "how easy can you get help from neighbors?" were defined as having difficulty getting help from neighbors during need. respondents who answered "none" or " - " to the question "how many people are close to you that you can count on if you have serious problems?" were defined as having less than people who they can count on for help for serious problem. finally those who answered "no", "little", or "uncertain" to the question "how much concern do people show in what you are doing", were defined as having people showing little concern in what they are doing. due to the interest in the pattern of psychological distress and social support among the respondents we analyzed each variable in the ghq and oss separately instead of using aggregate scores we recruited five resident doctors of the nigerian field epidemiology and laboratory training program [ ] as data collectors, who were part of the contact tracing team and had extensive experience with data collection from prior activities. they were trained for a period of days on the use of the study questionnaires and interview techniques prior to the onset of the study. data collection took place over a period of weeks and the average duration of each interview was min. data were entered into epi info . . , cleaned and edited for inconsistencies before analysis. we summarized our findings using frequencies, means (with standard deviation) and proportions. we used odds ratio (or) with % confidence interval ( % ci) to check for statistically significant associations and unconditional logistic regression to check for independent predictors of psychological distress. the evaluation was part of the evd outbreak response and was therefore exempted from ethical clearance by the evd emergency operation center in lagos. the evd emergency operation center however read and cleared the protocol before onset of the study. written informed consent was obtained from each participant after complete description of the study. as part of the response to evd, all the contacts, relatives and survivors who reported or had noticeable distress irrespective of whether they were part of this study or not, had access to counseling and other forms of treatment from the members of the psychosocial subgroup of the clinical management team. those found to have clinically significant psychological morbidity were counseled and all assessed to require specialist care were referred to the neuropsychiatric hospital, lagos. a total of interviews were conducted, of which three were disqualified because the interviews were not completed. the mean age of participants was +/ - . years, age range - years. of the participants, four ( . %) were survivors, ( . %) were contacts, ( . %) were contact relations and one ( . %) was a survivor relation (table ) . two thirds of the participants were females and ( . %) had a tertiary education. forty-five ( . %) were health workers and about half ( . %) resided in eti-osa local government area (lga) of lagos state ( table ) . the most frequently occurring psychological distress among all respondents were "not been able to concentrate on what you are doing" ( . %) and "lost much sleep over worry" ( . %). the least occurring psychological distress was "been thinking of yourself as worthless" ( . %). "not been able to concentrate on what you are doing" and "lost much sleep over worry" were the most frequently occurring psychological distress among survivors ( % and %, respectively) and among contacts ( . and . % respectively). only ( . %) of the participants reported "can count on less than people for help for serious problem" ( table ) . losing a relation to the evd outbreak (or = . , % ci, . - . ) was significantly associated with the psychological distress of "feeling unhappy or depressed" while being a health worker (or = . , % ci, . - . ) was protective. having no tertiary education (or = . , % ci, . - . ) was significantly protective against "not been able to concentrate", while living in eti-osa lga (or = . , % ci, . - . ) was significantly associated with "not feeling reasonable happy". all the four survivors reported they had, "not been able to concentrate" (table ) . losing a relation (aor = . , % ci, . - . ) remained an independent predictor of the psychological distress of "feeling unhappy or depressed". loss of a relation (aor = . , % ci, . - . ) remained an independent predictor of the psychological distress of "not been able to concentrate" while having no tertiary education (aor = . , % ci, . - . ) remained a protective factor against "not been able to concentrate" (table ). the most frequently occurring psychological distress among the respondents: inability to concentrate, losing much sleep over worry and being unhappy or depressed are key clinical features of anxiety, depression and post traumatic stress disorders (ptsd) as described in the diagnostic and statistical manual (dsm) of mental disorders [ ] . though the individual psychological distress does not amount to a neuropsychiatric disorder, it does indicate the presence of some psychological distress among the respondents that may have the potential to progress if not properly managed. evd can be perceived as a life-threatening event that meets a key diagnostic criterion of ptsd in dsm [ ] . the development of ptsd following life-threatening event has been demonstrated among nigerians [ ] and among health workers who had contact with severe acute respiratory syndrome (sars) [ ] . other less severe disorders caused by reaction to extremely stressful situations such as acute stress reaction and adjustment disorders could also present with the above psychological distress. the psychological distress of being unable to concentrate could be mistaken for cognitive impairment by the clinical management team if it occurs in a patient with evd, could be confused for viral encephalopathy or onset of brain damage secondary to evd infection. a case of adjustment disorder, in a survivor of the nigerian evd outbreak, initially diagnosed as having brain damage secondary to viral encephalitis is an example [ ] . losing a relation during this evd outbreak was significantly associated with being unhappy or depressed. this could be dismissed as a usual response to bereavement in people, but the feelings of depression (whether from normal grief or psychopathological) could have implication for the management of patients with evd or for the contact tracing team while monitoring contacts for clinical manifestation of evd. it could affect judgment and thus reduce cooperation with either the clinical management team or contact tracing team. feelings of depression could also cause patients or contacts of evd to tolerate emerging symptoms of evd thereby not reporting them to the management team. this could people show little or no concern in what you are doing ( . ) ( . ) ( . ) ( . ) complicate overall clinical impression of the patient or cause problems with determining the exact time of onset of clinical symptoms. the effect of an evd contact, with feelings of depression, failing to disclose important clinical symptoms may lead to delayed or failed recognition of evd onset with far reaching public health importance. the psychological stress of bereavement can mimic severe depression but also bereavement has long been described as a risk factor for development of depression [ ] . furthermore, it has been suggested that risk factors for common mental health problems arising from the evd outbreak such as witnessing and caring for individuals who are severely ill, perceived life threat, substantial mortality and bereavement, and the deaths of trained health care workers, in conjunction with the lack of well-trained mental health professionals in countries experiencing evd outbreak in west africa could amplify the risks of developing enduring psychological distress and progression to psychopathology by those affected [ ] . although the psychological distress the extensive social support base of the nigerian community, which is not limited to the immediate family members, may have helped the social support respondents had. poor social support was only a problem to less than a quarter of the respondents. this may have been due to the relatives not being aware of what the respondents were going through. overall, only few of the respondents demonstrated poor social support, respondents who had little or no interest shown in their activities were more likely to lack self-confidence. having no tertiary education, which was protective of inability to concentrate, may not be an entirely positive finding because it could reflect the lack of insight into the implication of an infection with evd by those without tertiary education. the study found loss of a relation to be an independent predictor of feelings of unhappiness or depression and inability to concentrate. contacts or survivors who have lost close relations should be considered at high risk of developing psychological distress or even psychological disorders. loss of a relation is a traumatic experience that has been shown to be a predictor of ptsd [ ] and depression [ ] among persons exposed to traumatic experience in nigeria. therefore the psychosocial response team for evd outbreak should prioritize this subgroup of contacts and survivors for special monitoring and evaluation. the contact tracing teams following up this subgroup of contacts should include a member of the psychosocial response team with training in detection of psychological distress/disorders. the findings of this study are subject to the following limitations. we only assessed for psychological distress and not disorders. only few survivors were sampled which limited the ability to independently look at the dynamics of psychological distress among them. the evaluation could not interview the anticipated number of relatives because some of the contacts did not inform their immediate family members about their status as evd contacts and therefore could not be interviewed. despite these limitations, we are confident the findings of this study reflect the possible psychological distress following being a survivor or contact of evd or a relation to any. we concluded that survivors and contacts of evd or their relatives develop psychological distress that could be predicted by loss of a relation and recommended that mental health specialists and social workers be part of the case management team of the response to evd outbreak. the clinical teams managing evd patients should be trained on recognition of psychological distress among the patients and recognition of common psychiatric disorders like depression that could follow evd infection, and special attention should be paid to those who have lost a relation. we also recommended the follow up of all survivors/contacts with increased risk of developing psychological distress or disorders for a minimum period of months by a mental health specialist for early detection of mental health disorders following evd. the findings of this study were shared with the ebola emergency operation center in lagos and the main findings were equally presented to the meeting of the association of psychiatrists and allied professionals in nigeria. 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meta-analysis of risk factors for depression in adults and children after natural disasters the ebola outbreak and mental health: current status and recommended response correlates of depression among internally displaced persons after postelection violence in kaduna, north western nigeria submit your next manuscript to biomed central and take full advantage of: • convenient online submission • thorough peer review • no space constraints or color figure charges • immediate publication on acceptance • inclusion in pubmed, cas, scopus and google scholar • research which is freely available for redistribution submit your manuscript at www the authors declare that they have no competing interests.authors' contributions am conceived the study and developed the initial and subsequent drafts. key: cord- -rm c vu authors: odusanya, kayode; adetutu, morakinyo title: exploring the determinants of internet usage in nigeria: a micro-spatial approach date: - - journal: responsible design, implementation and use of information and communication technology doi: . / - - - - _ sha: doc_id: cord_uid: rm c vu the dearth of information communication technology (ict) infrastructure in the sub-saharan africa region underscores the argument that the spread of broadband infrastructure can foster internet adoption in the region. consequently, the aim of this paper is to present results on the determinants of internet adoption in a sub-saharan african country. drawing on a dataset of households in nigeria, this study presents findings on the demographic, socio-economic and infrastructure factors that predict internet usage in nigeria. the novelty of our analysis stems from a unique dataset constructed by matching geo-referenced information from an inventory of network equipment to a nationally representative street-level survey of over , nigerians, by far one of the largest technology adoption surveys in sub-saharan africa to date within the information systems literature. the results are discussed and concluding remarks highlighting next steps are made. internet access is perhaps one of the most significant indicators of human and socioeconomic development. it fosters productivity and innovation (avgerou ; paunov and rollo ) , social interactions (liang and guo ) and reduces communication and search costs (beard et al. ). yet, there is a digital divide in the level of internet access among developing countries, especially those in sub-saharan africa (ssa) compared to the rest of the world. within ssa, the lack of internet access is a recognized barrier to the adoption of information communication technologies (icts) (afolayan et al. ) . this argument seems to be supported by regional broadband statistics, as shown in fig. where ssa is portrayed to have the lowest levels of internet penetration and wireless broadband infrastructure per capita, relative to other regions of the world. while previous studies have shed light on the regional variation in internet adoption by focusing on the determinants of internet penetration in the context of the "digital divide" (e.g. oyelaran-oyeyinka and lal ; chinn and fairlie ) , these studies often employ infrastructure measures/proxies (such as fixed telephone lines per sq. km, main telephone lines per capita, etc.,) thereby overlooking the peculiar nature of broadband infrastructure in the ssa region. more specifically, we note that internet use across the ssa region is undertaken mainly via wireless broadband access, rather than fixed-line broadband. thus, in this paper, we draw on a unique dataset that combines geo-referenced (longitude and latitude) information on g and g wireless network equipment to examine factors that predict of internet usage in nigeriaa sub-saharan country. consequently, this study offers two potential contributions to the literature. first, unlike previous studies, we demonstrate a measure of broadband infrastructure is micro-spatial in nature, i.e., it is based on the density or concentration of g and g equipment around each household's dwelling over specified spatial domains. to achieve this, we match street-level information from the technology survey to the global positioning system (gps) coordinates of g and g cell towers. this microspatial approach renders more nuanced and invaluable insights on whether/how spatial proximity or access to wireless internet connection shapes adoption decisions at the local level. afterall, without connectivity, it is practically impossible to adopt/use broadband services. furthermore, this spatial approach also embodies the reality that signal quality, a key determinant of actual usage behaviour, is shaped by the physical proximity of users to broadband connections (neto et al. ; destefano et al. ) . hence, in addition to treating the spatial diffusion of wireless network infrastructure as an appropriate measure of broadband infrastructure, it is also a quality-weighted indicator that enriches our analysis. second, our focus on nigeria provides a plausible and timely case study of the effect of broadband infrastructure diffusion on internet usage in ssa and the broader developing country context. given that it accounts for the largest proportion ( %) of the entire ssa region's . billion population (world development indicators, ), we would argue that nigeria is the most representative country of the ssa region. furthermore, itu estimates indicate that more than % of the youth population in developed countries use the internet compared to % in less developed regions of the world. considering that the proportion of nigeria's population below years is projected to reach % by , broadband penetration is likely to have a significant role in shaping nigeria's participation in an increasingly digitalized future economy. finally, despite growing to become africa's largest economy and one of the major emerging economies in the world, nigeria epitomizes the co-existing low levels of internet penetration and ict infrastructure deficit (the economist ). the remainder of this paper is organized as follows. in sect. , we undertake a critical review of related literature on internet adoption and ict infrastructure. this is followed by the model specification and the methods section. in sect. , we discuss the results and conclude in sect. highlighting next steps and expected contributions of our study to the information systems literature and policy. the literature on internet adoption and penetration is large. consequently, due to space constraints, the goal of this review is not to present an extensive discussion of existing literature. rather, we highlight a gap in the use of proxy measures in accounting for technology adoption. a more comprehensive review can be found in cardona et al. ( ) . a dominant strand in the literature pertains to cross-country studies aimed at evaluating the determinants of internet usage and penetration in the context of the digital divide in developing countries. one of such studies is dasgupta et al. ( ) who investigated the determinants of internet intensity (internet subscriptions per telephone mainline) for a cross country sample of oecd and developed countries. similarly, chinn and fairlie ( ) provide an analysis of internet penetration using a larger sample of based on panel data for countries over the - period. they control for a range of macro-level determinants on telecoms prices, per capita income, education, age structure, urbanization, regulatory environment, etc. although this study also controls for ict infrastructure, their reliance on telephone density may not be applicable to the african context. other internet diffusion/penetration studies use large cross-country samples from developing regions of the world (e.g. chinn and fairlie ) . a few studies however focus on internet penetration for more specific sub-groups/regions of the world such as oecd (lin and wu ) , the americas (galperin and ruzzier ), apec (liu and san ) , africa (oyelaran-oyeyinka and lal ) and asia (feng ) . greenstein and spiller ( ) investigate the impact of telecommunication infrastructure (measured by the amount of fiber-optic cables employed by local exchange telephone companies) on economic growth in the u.s. roller and waverman ( ) investigate the linkages between broadband investment and economic growth across oecd countries and developing countries during to . more recent studies have focused specifically on the impact of broadband infrastructure. for instance, czernich et al. ( ) investigated the effect of broadband infrastructure on the economic growth for a panel of oecd countries over the period [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] . however, they model this relationship by analyzing how broadband infrastructure (proxied by broadband penetration) shifts the growth parameter of technological progress within a macroeconomic production function setting. tranos ( ) explored the causal effect of broadband infrastructure (internet backbone capacity) on the economic development across european city regions over the period - with ict infrastructure found to stimulate economic development. three important observation can be gleaned from the above literature review. first, the cross-country studies tend to focus on the digital divide, attempting to explain internet adoption and penetration based on changes in economic, social, demographic and regulatory/institutional factors. even when these studies attempt to account for the role of telecoms infrastructure, they do so by using variables such as personal computers per people, main telephone lines per people, customers' equipment (e.g. telephone set, facsimile machine), etc. second, studies based on microdata tend to focus on developed country contexts, while also relying on infrastructure proxies that are analogous to the cross-country studies. moreover, the developing country studies are not free from this problem too. third, even studies that focus mainly on the effect of ict infrastructure on economic measures and internet adoption also employ similar ict infrastructure measures such as investments in telephone/broadband cables. in comparison to the cited studies, we take a different approach by employing a true measure of internet infrastructure that is based on the prevalence of wireless network equipment (i.e. towers and radios). we then explore the effect of wireless network access on internet adoption at the individual level, based on physical proximity to broadband connection. research has shown that variations in technology adoption are shaped by heterogeneity in geographical network access, such that the physical proximity to broadband connection or infrastructure can be expected to shape adoption decisions at the local level. for instance, it is well established that urban areas benefit from higher concentration of ict infrastructure, which may enable social learning and adoption of ict technologies (liu and san ) . hence, unless this type of analysis is undertaken, these disparities in network access may be inadvertently explained away as differences across individual income or demographic characteristics. this paper is also related to a small and evolving body of studies that exploit spatial data towards analyzing the diffusion of telecommunications technologies. our review shows that research conducted by buys et al. ( ) and hodler and raschky ( ) come close to the line of inquiry pursued in this study. however, they differ significantly from this study in two crucial ways. firstly, both studies conduct country-level spatial analysis while we adopt a micro-level spatial approach. secondly, while the former investigates the determinants of mobile operators' spatial location of network sites across sub-saharan africa, the latter explores the role of ethnic politics in shaping the spatial diffusion of mobile phone infrastructure in africa. as far as we know, the closest relative to this study is destefano et al. ( ) where the authors investigated how the arrival of adsl broadband technology influenced the it-productivity gap among uk firms. comparatively, this study is therefore the first to explore the individual-level influence of broadband infrastructure on internet adoption using a micro-spatial approach, especially in a developing country context. this study uses a probit model to examine the determinants of internet usage in nigeria. probit models are used when the dependent variable is dichotomous. we employ a set of explanatory variables in our model, namely: demographic factors include age, gender, marital status and religious affiliation; socio-economic factors such as expenditure, education, whether they are employed or not and a location variable indicating whether respondents live in rural or urban areas. finally, we also include a micro-spatial infrastructure representing the number of internet infrastructure within a radius of where they live (i.e. towers) and the average tariff per megabyte of data used (tariff). both towers and tariffs represent our infrastructure variables included in our model. thus, our model is represented by the equation: internet use = f (age, gender, income and education, marital status, religious affiliation, towers, tariffs, urban). we expect monthly expenditures (our proxy for income) to affect broadband adoption/usage positively. the probability of this adoption decision is also likely to rise for more educated individuals. however, the need for possessing an internet subscription, however, may fall for older and unemployed respondents. in terms of age, one could argue that, whereas younger individuals may have lower income, they tend to demonstrate a greater degree of technological affinity (hübler and hartje ) . we add a gender variable as an additional characteristic, given that the preferences and decisions of men are more dominant than the preferences of their spouse(s) in patriarchal societies (bulte et al. ) . similar considerations can be extended to the marital status of an individual on the adoption of internet technologies. finally, technology adoption decisions are often shaped by religious reasons, as some religious beliefs may restrict the adoption of conventional technological products (fungáčová, et al. ). hence, we control for the religious beliefs of each sampled individual. to examine the effect of broadband infrastructure on internet adoption, used a measure that captures individual-level access to wireless broadband network. hence, we employ a microspatial variable that captures the prevalence of wireless network infrastructure at the individual level. we calculate this variable using information from our two data sources in four steps. first, inspired by hodler and raschky ( ), we extract and map the g and g cell tower locations from opencellid (see fig. b in the appendix section). secondly, we extract and map the street-level dwelling locations from the survey data. thirdly, to use both data for our purpose, we link them by overlaying the towers map with the dwelling location map. finally, we compute a micro-spatial infrastructure variable as the total number of cell towers within -km radius of everyone. this -km specification is premised on the fact that network coverage in ssa is mainly based on base stations that can provide service up to a - km radius (aker and mbiti , p. ) . we achieve this using the stata 'spmap' command. to investigate the effect of wireless connectivity on internet usage, we rely on a unique nationally representative market survey of nigeria carried out by africa's largest mobile operator, mtn during april-july . the mtn survey, which covers localities (i.e., villages or towns), is by far and away one of the largest and most comprehensive technology surveys in sub-saharan africa to date. the data was collected via the use of paper questionnaire distributed to respondents in all states of the country. figure a in the appendix section plots the centroid gps coordinates of surveyed areas at the municipality level. the wide geographical spread of the survey areas confirms the nationally representative nature of the survey. a total number of , observations were obtained for the final analysis. our second data resource is the opencellid database which contains information on the micro-spatial independent variable (towers). the database contains raw information on the geo-location (longitude and latitude) of around seven million unique cell sites across the world (hodler and raschky ) . one key benefit of the opencellid database is the possibility to identify the technology (radio) type for each telecommunications tower (i.e. gsm, umts, lte, etc.). this allowed us to identify the two wireless network classes: "umts" (third-generation technology, g) and the more advanced "lte" (fourthgeneration technology, g) types. specifically, we identified a total of unique tower locations from the opencellid data consisting of g and g sites. these sites are geo-coded at the gps (longitude and latitude) -level (see fig. b in the appendix). our main dependent variable is represented by a broadband usage variable for the use of broadband services. to construct this indicator variable, we convert survey responses on broadband subscription using the question: "which of the following telecommunication services do you use nowadays?". we then calculate the dependent indicator variable as a dummy that takes the value " " if "data service (accessing internet)" was selected in response to the question. otherwise, a dummy value of " " was assigned to the observation. table provides the summary statistics of the variables employed in this study. the internet adoption rate within our dataset is %, falling firmly within the same ballpark as the . % and . % broadband penetration rates reported by business monitor international (bmi ) and the itu, respectively. the summary statistics in table also indicate that there are on average wireless network towers within km of each respondent's street. however, the standard deviation of towers within the km radius suggests a reasonable spread or dispersion of the cell tower variable. table presents the marginal effects from baseline probit estimations. in column , we start by measuring the network infrastructure effects on broadband adoption: probability of adopting internet services, without any control variables or locality effects. due to the cross-sectional nature of our data, we interpret these results as associations. it is clear from the results in columns ( ) that a strong positive correlation exists between the concentration of broadband infrastructure around each individual and internet adoption. this coefficient is significant at the % level. from column to , we add the control variables one by one, but the infrastructure coefficient remains statistically significant at the % level, albeit the magnitude of the coefficient drops. in column , we include locality effects to draw inference only from the variation in individual adoption decisions. besides employing controls and locality effects, we use heteroskedasticity-robust standard errors clustered at the locality level that allow the data to be independent across localities by restricting the error terms to be correlated for individuals within the same areas on account of omitted regional characteristics. ÃÃÃ, ÃÃ, and à denote significance at the %, %, and % level, respectively. as seen in column , the infrastructure coefficient retains its statistical significance but drops further. specifically, infrastructure coefficient of . suggests that a unit increase in the number of cell towers within km of a respondent increases the probability of internet adoption by . %, which corresponds to an increase in the likelihood of adoption from around % to around . % in an average respondent. also, in the full specification in column , the coefficients on the control variables are consistent with intuition and they are all statistically significant at the %-level. for instance, older and unemployed respondents are less likely to adopt broadband services, whereas higher income earners, more educated individuals and urban dwellers are more likely to adopt the internet. for religion, being a christian increases the probability of adoption. the positive coefficient on the male gender variable is consistent with the patriarchal nature of the nigerian society, which indicates that the men are more likely to adopt internet services, perhaps reflecting the stronger socioeconomic power of the male gender. interestingly, in terms of the magnitude of the coefficients, we find age and gender to have the greatest effect on broadband adoption, with both coefficients indicating % and % positive impact on the probability of adoption, respectively. the age coefficient lends weight to our opening arguments on the implications of broadband adoption for the participation of the large projected youth population of nigeria in an increasingly digitalized global economy in the future. for all the specifications in table , the results also show that individuals in areas with a higher concentration of network infrastructure are more likely to adopt and use broadband services. this paper presents first-stage results showing factors that influence internet adoption in nigeria. using geo-referenced information of an inventory of broadband network infrastructure, we employ a more appropriate micro-spatial measure of internet infrastructure based on g/ g network equipment at the local level alongside a range of explanatory variables to explain internet adoption in nigeria. in general, the results obtained are economically important, and they can help explain the adoption patterns of broadband services particularly when network infrastructure effects are likely to play an important role in driving internet penetration. for instance, in many regions across developing countries, network coverage is usually the first modern technology of any kind (aker and mbiti ) . hence, we would argue that the failure to control for this network infrastructure effect in the study of broadband adoption across developing countries could well result in significant omitted variable bias. furthermore, the network infrastructure effect may also explain the nuances embodied in the varied adoption of broadband services across different regions, given that the quality of service (qos) and user experience may well depend on the diffusion and reliability of the underlying network infrastructure. although the first-stage results presented in this paper revealed preliminary drivers of internet adoption, they also provide interesting avenues for further study which we aim to explore in subsequent analysis of the dataset. in the first place, the significant urban variable shows that there are likely to be regional differences with regards to the factors that influence internet adoption in nigeria. given that nigeria has one of the largest rural population in africa (world bank ), we expect that further analysis testing the relationships in this study across rural and urban dwellers, will contribute significantly to the policy debate on bridging the urban-rural internet divide in nigeria. further, having microeconomic information that is representative of the national population of the type used in this research, permits clear visualization of the digital divide as an additional form of inequality that can hinder access to other internet-reliant technologies. for instance, the telecommunications sector in nigeria is currently undergoing several policy changes, one of which is the granting of mobile money licenses to mobile network operators. therefore, it is earmarked that further analysis with our data will explore diffusion constraints for other technologies covered in the survey data and how usage patterns might vary in different parts of the country. we hope that the results of these avenues of research will provide new insights that contribute to both policy and research. − . *** − . *** − . *** − . *** − . *** − . *** − . *** − . *** *** − . *** − . *** − . *** − . *** − . *** information technology usage in smes in a developing economy mobile phones and economic development in africa information systems in developing countries: a critical research review internet use and job search business monitor international (bmi): nigeria telecommunications report gender training and female empowerment: experimental evidence from vietnam determinants of a digital divide in sub-saharan africa: a spatial econometric analysis of cell phone coverage ict and productivity: conclusions from the empirical literature the determinants of the global digital divide: a cross-country analysis of computer and internet penetration ict use in the developing world: an analysis of differences in computer and internet penetration broadband infrastructure and economic growth policy reform, economic growth and the digital divide broadband infrastructure, ict use and firm performance: evidence for uk firms determinants of internet diffusion: a focus on china trust in banks price elasticity of demand for broadband: evidence from latin america and the caribbean modern telecommunications infrastructure and economic activity: an empirical investigation ethnic politics and the diffusion of mobile technology in africa are smartphones smart for economic development? social interaction, internet access and stock market participation-an empirical study in china identifying the determinants of broadband adoption by diffusion stage in oecd countries social learning and digital divides: a case study of internet technology diffusion fostering pro-competitive regional connectivity in sub-saharan africa. global ict department internet diffusion in sub-saharan africa: a cross-country analysis has the internet fostered inclusive innovation in the developing world? world dev telecommunications infrastructure and economic development: a simultaneous approach the causal effect of the internet infrastructure on the economic development of european city regions rural population -nigeria acknowledgements. the authors also gratefully acknowledge the support of africa's leading mobile operator mtn, for providing the market survey and operator data employed in this study. special thanks to the staff of the business intelligence and research departments. we also like to thank participants at various seminars and workshops for their helpful comments. the usual disclaimer applies. opencellid data) key: cord- -z mttvep authors: watts, professor michael; zalik, dr. anna title: consistently unreliable: oil spill data and transparency discourse date: - - journal: extr ind soc doi: . /j.exis. . . sha: doc_id: cord_uid: z mttvep our recent research reveals enormous discrepancies in oil spill data disclosed by regulatory institutions and corporate sources in nigeria. federal agencies as well as major international oil corporations publish inconsistent and sometimes contradictory figures, often employing different spatial or regional categorizations. uncertainties pertaining to data veracity in the niger delta, alongside the thin scientific record inflect deeply contentious debates regarding the country's oil industry. for advocacy organizations, the result is that those seeking to monitor oil spills may spend hours trying to square and cross-reference uneven information, time that could otherwise be spent assessing the scale of impacts and analyzing the complex structural causes surrounding them. scholarly work in other jurisdictions indicates that the staging of non-transparent, incoherent and/or intentionally misleading data on oil spill risks is not unique to nigeria, leading to a kind of epistemological vertigo in studying this sector. sometimes contradictory figures, often employing different spatial or regional categorizations. uncertainties pertaining to data veracity in the niger delta, alongside the thin scientific record inflect deeply contentious debates regarding the country's oil industry. for advocacy organizations, the result is that those seeking to monitor oil spills may spend hours trying to square and cross-reference uneven information, time that could otherwise be spent assessing the scale of impacts and analyzing the complex structural causes surrounding them. scholarly work in other jurisdictions indicates that the staging of non-transparent, incoherent and/or intentionally misleading data on oil spill risks is not unique to nigeria, leading to a kind of epistemological vertigo in studying this sector. epistemology; oil spill data; transparency; nigeria; oil industry one of the striking characteristics of the oil and gas industry is that its putative high-tech veneer -deep water technologies, sophisticated monitoring and surveillance systems, complex infrastructural networks -coexists with a body of data on its global value chain wildly patchy in its coverage and often unreliable and untrustworthy. poor and remarkably unreliable data sit uncomfortably with scientific precision and technological complexity. it is well known of course that the international oil companies (iocs) -exxon in particular (mulvey et al ; hall ) -have long been in the business of selling doubt and providing what can only be described as fake news; but governments in oil-states are also implicated. in this sense, the world of oil and gas is a textbook case of the agnotology discussed by proctor (proctor ) . the reams of data and statistics produced on the oil and gas sector actually present a highly distorted picture of what we do and do not know about the industry's operations (power ; barry ; zalik ) . sketchy or inconsistent information has been the touchstone of course for the transparency and disclosure movements, particularly around revenue flows and capture. any novice endeavoring to come to terms with the industry is thus immediately confronted by what can only be described as a sense of epistemological vertigo: nothing quite seems to add up -booked reserves, the life cycle of reservoirs, the releases of flared gas or the quantities of oil spilled, it all floats in a miasma of ambiguity and untruth. knowledge production within the industry itself -the process by which data is produced, catalogued, organized and rendered credible or valid -leads the researcher, in short, to be deeply suspicious. what is at stake is a sort of political economy of ignorance or distortion. nowhere is this clearer than in the numbers and measures surrounding the ecological footprint of the industry, and the safety and security of the infrastructure. an important test case is the data record on oil spill incidents and the attribution of cause. despite attentiveness and critique of partial and misleading information related to the oil industry arising from long-standing scholarship on the subject, our recent research in nigeria has shockingly underlined the problem. we have been confronted with enormous discrepancies in oil spill data disclosed by varied regulatory institutions and corporate sources in that country. federal agencies as well as major international oil corporations publish inconsistent and sometimes contradictory figures, often employing different spatial or regional categorizations. uncertainties pertaining to data veracity in the niger delta, alongside the thin scientific record, inflect deeply contentious debates regarding the country's oil industry. for advocacy organizations, the result is that those seeking to monitor oil spills may spend countless hours trying to square and cross-reference uneven information, time that could otherwise be spent assessing the scale of impacts and analyzing the complex structural causes surrounding them (amunwa ) . data inconsistencies concerning oil spills in nigeria's niger delta are egregious, but the region has no monopoly on unreliable and contradictory data. our research in other jurisdictions -notably canadaindicates that the staging of non-transparent, incoherent and/or intentionally misleading data on oil spill risks is not unique to nigeria (kheraj ; gilbert and zalik ) . indeed, canadian regulatory agencies also employ divergent standards and definitions to assess spill events, thereby offering incommensurable data at the national level. accordingly, the production of inconsistent and unreliable data points to broader questions of industrial 'best practice' in the international oil industry and reveals the incomplete and inconsistent application of transparency discourse. at present data on oil spills in nigeria is gathered and organized by a number of different institutions: the nigerian oil spill data response agency (nosdra, established in ) , key international oil companies operating in the niger delta -shell petroleum development company (spdc) and nigeria agip oil company (naoc), statistics published via the nigerian national petroleum corporation (nnpc) and the department of petroleum resources (dpr), as well data included in reports prepared by civil society organizations and foundations. raw data from the nnpc is difficult to acquire, unless it has been published in scholarly journals or research reports where authors were able to obtain access. the most accessible data is that provided by nosdra via its oil spill monitoring site (https://oilspillmonitor.ng/) which provides data on oil and gas spills from to the present. on its face, the very existence of this data in the public domain (the raw data can be analysed by any researcher) is worthy of many accolades. but most notable upon a review of a review of the information is the poor quality of the official and publicly available data, and the substantial discrepancies that exist between different sources (for example between company data on spills the nosdra data and other nigerian official such as the department of petroleum resources (dpr) and the nnpc. discrepancies of the order of - % emerge in even a cursory comparison of nosdra and spdc reportage of spill events . similarly, there are significant discrepancies over gas flaring venting quantities according to nnpc, company and noaa (satellite estimations). for example, estimations of emissions (in millions of standard cubic feet mscf) in by nnpc (derived from financial reports) and by viirs satellite data differed by over % (see the world bank gas flaring reduction partnership (ggfr) [https://www.worldbank.org/en/programs/gasflaringreduction], and https://www.dw.com/en/gas-flaring-continues-scorching-niger-delta/a- . according to the nosdra oil spill monitor website, the national picture of oil spills ( ( -march is a total of , spill events and a total release of , barrels. of these events, . .% of the incidents pertained to crude oil accounting for . % of total spill contaminants. the spatial distribution of spill events and spill volumes vary sharply across states (rivers state alone accounts for just under % of all spill incidents -followed by bayelsa and delta -and . % of the total quantity spilled). about yet publicly available data from the nigerian national petroleum corporation contrasts markedly with this statistical picture. data on pipeline malfunction ('vandalizations' and 'ruptures') is provided by nnpc in its annual statistical bulletin but these are aggregate figures for the whole of the country (though the vast majority occur in the niger delta) . nnpc pipeline loss data (for the five regions of the country) documents over , incidents since which amount to a quantity of oil lost almost times larger than the total spill volume for the niger delta on its oil monitoring site! of these are due to "equipment failure" (roughly . %). the volume of 'petroleum products' lost over that period was , , metric tons ( . million barrels) . data on 'crude oil losses' -only available for a five-year ( - ) -amounted to , , barrels, a figure more than times higher than that reported by nosdra for to the present ( , ). similarly a study comparing monthly oil spill data from nosdra with annual data from nnpc discovered -to take one example among many -a discrepancy in the year of between and in the number of annual spills (yeeles and akporiaye, ) . million barrels of oil" of which more than % was not recovered (undp , p ) .two-thirds of these spills ( %) occurred off-shore, a figure which seems implausible. another widely cited source is a study published by the woodrow wilson center. this estimates million gallons were spilled in nigeria between - , at an average of . million gallons petroleum production loss statistics are derived from nnpc annual statistical bulletins. over the period - (following the return to civilian rule) pipeline product losses amounted to an astonishing , , metric tons ( . million barrels) from events, of which % were in the warri and port harcourt zones; . % were attributed to 'rupture' (and . to 'vandalization'). spilled annually from approximately spills (francis, lepin et al , p. ) . given the ratio gallons per barrel, this is a figure of approximately , barrels per year or more than , , barrels over years. it is inevitable that there will always be some sort of discrepancy when differing agencies and institutions have responsibility for the organization of data of a common topic, but the scale of discrepancies in the nigerian case are bewildering. among other things this points to the fact that after seven decades of pumping oil and a record of massive despoliation of the environment -the niger delta is often described as the most polluted place on the planet -the scale of the enormity of the problem remains the subject of debate. ioc data generally records lower spill volumes than nosdra. nevertheless, some of their data includes https://www.wilsoncenter.org/sites/default/files/afr_ _niger% delta_ .pdf on p . see https://www.shell.com.ng/sustainability/environment/oil-spills.html site certification "planned to be completed may '. although a jiv survey and report file are named and visible on the spdc cite, a cross reference on the nosdra site turns up no recorded spill equivalent to this event. we reference this as a relatively large spill caused by operational failure in a riverine zone where spills are frequently categorized as sabotage. additionally, the spdc spill record indicates the terrain as land when in fact oporoma is located in the creeks, and thus should be categorized as 'swamp' -a factor of importance given the difficulty of measuring spill spread in riverine areas. such problems in formal spill reporting processes have been documented at some length by the organization accufacts in their analysis for a amnesty international report discussed in the next section. the data that is entered in the nosdra database is the product of oil industry analysis and the 'joint investigation visit' -a formal process requiring site visits by the company, in conjunction with state regulators and community representatives. the jiv process has been contested for years as subject to undue influence by the firm which finances the visit, in part because the firm covers expenses and provides per diems to those who participate. state representatives, in particular, whose salaries are limited and frequently irregular due to blockages in payment from state coffers, are viewed as easily subject to firm pressure. participation in jiv processes may indeed involve a significant supplement to their income ; our ongoing research and ngo reporting document various cases where state or community representatives indicate that jivs were not approved yet filed, that non-representative community members were paid to sign, and that per diems or expense payments have been withheldor were threatened to be withheld -due to non-compliance (amnesty (amnesty , nacgond ; sdn ; rim-rukeh ) . in addition to the jiv form, the federal oil spill reporting process in nigeria requires oil firms to submit to nosdra three other forms : there is an oil spill notification report (form a) to be submitted within hours of spill which records the date of spill, its observation, location and containment and the site impacted and extent of impact. subsequently a 'risk based assessment' (form b) is to be submitted by the oil company whose facilities are affected within two weeks of a spill; this includes clarifying information on the cause, method of containment, weather conditions at time of observation and some further details on the spill extent and impacts as well as a proposed clean-up. this is to be further the agreement among the parties has been a key source of controversy. a number of actors are legally involved in the production of the jiv: the company, community representatives, and state regulatory the templates for forms a-c and the jiv are available at http://nosdra.gov.ng/forms.php agencies. the entire process is, in theory, subject to a set of legal norms to ensure that the response system (the jiv) is reliable (speedy data collection and recording methods and management), accurate (measurement and assessment of damage and environmental impact), viable (establishment of a baseline record for future referencing), and accountable (perceived integrity of the data recorded). in all four respects it has been widely documented (see for example amnesty , , sdn , nacgond , rim-rukeh that the oil spillage response system -on the part of both companies and regulatory agencies -is deeply flawed, in some cases corrupt, and -as currently implementedincapable of providing a reliable, accurate (and transparent) assessment of oil spills quantities, spatial distribution and dispersion, causality and clean-up. to the degree that the response data are questionable, the estimates on compensation, costs and requirements for clean-up and ecosystem rehabilitation are also necessarily in doubt. a widely publicized amnesty international report examines the problematic nature of the data produced via the joint investigation visit (jiv) process. there a is strong incentive for the operating firm to attribute cause to sabotage rather than operational failure. the same applies to the nigerian state and given the joint venture arrangement through which the nnpc is majority shareholder. the participation of representatives of state regulatory institutions present at these investigations is financed by the operating firm. operators may withhold per diems or offer kickbacks each of which influence the real and perceived objectivity of these representatives. there are also significant financial and structural factors likely to produce under-estimates of spill volumes. among these, the volume of the spill drives estimates for compensation, yet companies -with a clear conflict of interest in the results-essentially control the estimates. the amnesty report notes various irregularities in presented data. these include major discrepancies between publicly posted spdc data and the data indicating spills attributed to spdc on the nosdra website, and the data reported by shell's nigerian subsidiary spdc versus royal dutch shell internationally in the period - . as we discussed above, a review of the information posted by shell and nosdra since reveals that this discrepancy has continued. spdcs data indicates a lower number of spills to those reported by nosdra. however, despite the lower number, spdcs data includes spills that are not searchable in the nosdra database. the amnesty report further reviewed a shell environment brief which offered a very different picture of the cause of spills than those reported today. "historical data on oil spills by company are not available, except for shell. between and the company reported an average of spills per year. according to shell, during this time period percent of the oil spilt by volume was due to corrosion, percent due to operational problems and percent due to sabotage." (amnesty , p. ). amnesty describes, via procedural unpacking by accufacts, the political economic bias in the jiv and nosdra data we refer to above. an accufacts survey revealed serious problems in the technical basis of spill assessment: for instance, teams assess surface area based on rough measurements. they reviewed various photos from jivs which had been deemed sabotage in the jiv process, yet which accufacts re-assessed as the result of corrosion or welding failure. in particular, the use of both ) ultrasonic readings (ut) and ) the use of the 'o'clock' position to ascertain sabotage as cause are appraised as inaccurate and unscientific, accufacts explains: the jiv reports do not provide sufficient information to verify or properly support the indicated determination of cause. preconceptions (such as evidence of loose soil at the release site, location of the pipe failure site -top of pipe is sabotage, while bottom of pipe is corrosion, or hole appearance) introduce prejudiced and highly probable false conclusions as to the real cause of the pipe's failure. based on an accufacts review of photographic evidence of some of the claimed niger delta pipe failures, cause determinations based on the information entered on current jiv reports can be very subjective, misleading, and downright false (amnesty , p. ) . additional technical problems arise in the assessment of spill volume. the assessments made in the field, and the data on flow which firms state they use to assess spill volume are inconsistent, in part because jiv teams arrive late to spills and are insufficiently resourced. accufacts indicates that these assessments should be understood only as approximations and are likely to underestimate flow. among the limitations spills which have moved downstream by the time the jiv occurs are not accounted for, and that density is poorly measured (amnesty fn p - ) . insofar as many spills are in or close to water sources -creeks, rivers, swamps, oceans -cumulatively these flow underestimates are substantial. based on an accufacts example, amnesty documented a particularly egregious example from the bodo, ogoni area of rivers state that garnered international coverage. initially, the jiv process assessed a leak in bodo spilling , barrels of oil which led to just $ , of compensation. when the case was taken to the uk courts, the compensation award was increased to $ m, with amnesty estimating that the actual volume spilled was around , barrels- times greater than assessed by the jiv process. according to shell, the spill amounted to a total of , barrels of oil but accufacts " found that as summarized by accufacts: "estimating the amount of oil spilled from a pipeline from field observations utilizing surface area methods can be very poor at accurately arriving at a true final number for oil actually released because of such factors as: ) evaporation effects, ) migration (both surface and subsurface), as well as ) errors/uncertainties in measurement/ assumption. surface area approaches might be adequate for small rate (small hole/ opening or crack releases of a short duration) affecting a small area, but will most likely significantly underestimate oil released for larger opening/ much higher rate, longer duration releases, especially pipeline ruptures over a widely dispersed area. accufacts' experience would indicate that, especially for large oil spills, such as those associated with pipeline ruptures, the surface area approach can seriously underestimate the volume of oil spilled. surface area approaches can particularly miscalculate spilled quantity if local environments can permit the rapid migration of oil in land (hills) or water (such as moving water)" (cited in amnesty , p. ). between one and three barrels of oil were leaking per minute -this amounted to between , and , barrels of oil flooding the bodo area each day" (amnesty , p. , fn ). despite these significant problems with the data, certain patterns within it are revealing. it is notable that nosdra's own data indicates that the largest individual spills in the central niger deltan state of bayelsa are caused not by sabotage, but by operational failure, maintenance error or pipeline corrosion. squaring with this, prior to the establishment of nosdra the above referenced shell environment brief recorded that between - , % of oil spilt by volume was due to corrosion and operational problems whereas only percent was due to sabotage (cited in amnesty , p ). whanda et al also demonstrate the considerable proportion of spills attributable to corrosion and production error from - based on department of petroleum resources data predating nosdra's establishment (whanda et al ) . but this causal attribution changes markedly in the subsequent data sets (obida et al ) .given the difficulty in causal attribution of so-called 'mystery leaks' -oil spills for which the source is not identified-and the structural motivation by the firm to characterize as many spills as possible to sabotage, this figure is notable. as the overall attribution to sabotage is itself suspect for the reasons discussed above, there is a significant likelihood that a considerably greater volume of oil spilled may result from direct operator error than nodsra data suggests. ultimately much of the contention surrounding who and what is responsible for pollution in nigeria's oilfields arises from an uneven and ambiguous scientific and statistical record, some of which may result from direct obfuscation. serious discrepancies exist between sources. the assignation of cause to those oil spills documented in the publicly available data is especially contentious. until the unep study on the ogoni region, precious little high-quality environmental data existed, and the reliability of, and confidence in, oil spill data decreases as any investigation pushes further back in history. data pertaining to the s and s and even into the s for example is scanty, yet it is known that there were massive spills during the first decades of oil production (anejionu, ahiarammunnah & nriezedi , ) . among these, there were massive spills in (at forcados) and (the funiwa offshore well # ) each of which exceeded by most estimates , barrels, yet there has been no full accounting of either (kostianoy et al ) . the trade-off between northern development and southern impoverishment have been a central direction of critical anti-colonial scholarship for much of the past century (rodney ; okonta and douglas ) . the implications of extensive global environmental injustice prompt the reassessment of sustainability measurement on a transnational scale (veraart, smits and van der vleuten ) sciences that establishes a causal relationship between oil spills and neo-natal mortality in the region (bruederle and hodler ) . the 'epistemological vertigo' that arises from reviewing inconsistent data in a four year period between and there were five spills which alone amounted to over million barrels; during this period there were variously between and spills each year (see undp ; kadafa ). as far we know there is absolutely no reliable data on oil spillage between and including the fact that that a civil war was prosecuted in and around the oilfields; in the s nigeria prior to the civil war ( ) ( ) ( ) ( ) nigeria produced between and , barrels per days, and between and between and million barrels per day. see kostianoy et al . points to the need for rigorous ongoing toxicological and health research as an essential component of assessing and remediating the long-term impacts of egregious oil pollution in the niger delta. as we outline herein, the discrepancies in available data on oil spills in nigeria's niger delta are astonishing, a challenge for regulators, advocacy organizations and scholars alike. yet as nwadishi and nnimmo bassey point out in this issue, environmental data is a clear gap in the material generated via formal nigerian extractive industries transparency initiative audits, even in nigeria where civil society pressure has led to significant disclosures through the eiti. of course in its original design eiti was not intended to be a tool for the exploration and determination of the costs of operations on the ground on the oilfields (van alstine ; haufler ). as growing numbers and volumes of oil spills have been attributed to sabotage, however, upon which basis the oil industry withholds compensation, the question of pollution is increasingly central to the issues of financial transparency and revenue allocation in the niger delta. decades of pollution and its impact on local agrarian production, arguably, have created the conditions in which tapping of pipelines is one of the few sources of reliable income available to many local youth which complicates the question of 'cause' even in the case of clear sabotage. understanding and quantifying historical and ongoing pollution is thus central to assessing livelihood options available to niger deltan residents. the data problem can only be grasped by unpacking the means through which knowledge is produced and organized and the powerful interests in involved in shaping the nature of spill data and the attribution of cause (and liability). such flaws in data on oil pollution are not unique to the nigerian context. research on the canadian context, including by the canadian broadcasting corporation, has revealed inconsistent and misleading spill reporting (pereira , winter , kheraj, , gilbert and zalik . there is no single definition of a pipeline 'spill incident' under canadian law, which leads to confused regulation and reporting across crown land -under both provincial and federal jurisdiction. we note in our work on the oil industry in nigeria and elsewhere that the time commitment involved in reviewing such inconsistent data diverts attention from the broader question of accountability for socioecological deterioration. the absence of full-cost accounting for environmental harm allows extensive capital accumulation for corporations and shareholders (franks et al ), while impoverishing those who reside next to sites of oil production. we agree with critics who underline that environmental valuation cannot on its own bring about the structural changes required for the systems associated with the oil and gas sector to confront ecological and climactic consequences of hydrocarbon extraction and use (lohmann ) -whether in nigeria or internationally. nevertheless, consistent and reliable data on oil spill quantity would allow for a financial estimate of the net present value of surface pollution caused by decades of oil spills; this would likely emphasize the massive compensation owed to residents of the niger delta. as we complete this article in the context of the covid pandemic, the mutual constitution of socio-ecological deterioration and world trade flows has perhaps never been more evident. refashioning the broader political economy in the aftermath of this global lockdown demands we produce a more complete understanding of transnational extraction and exchange, and design systems that internalize and account for the socioecological damage arising from global industry, commodity production and provisioning. some of the research undertaken for this article was conducted by the authors as members of the expert working group of the bayelsa state oil and environmental commission. the views expressed in the article are solely those of the authors and do not in any way reflect the opinions of the expert working group or the commission. the true tragedy: delays and failures in the tackling of oil spills in the niger delta. amnesty international publications amnesty international/cehrd. . bad information: oil spill investigations in the niger delta clean it up: shell's false claims about oil spill response in the niger delta negligence in the niger delta: decoding shell and eni's poor record on oil 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in accountability, ethics and the academy the tyranny of transparency niger delta human development report critical reflections on years of the extractive industries transparency initiative (eiti) connected by oil: a framework to analyze the connected sustainability histories of the niger and rhine deltas geo-spatial analysis of oil spill distribution and susceptibility in the niger delta region of nigeria safety in numbers: evaluating canadian rail safety data risk and resilience in the nigerian oil sector transparency, auditability and the contradiction of corporate social responsibility p - in key: cord- -aejbfk l authors: hilda, awoyelu elukunbi; kolawole, oladipo elijah; olufemi, adetuyi babatunde; senbadejo, tosin yetunde; oyawoye, olubukola monisola; kola, oloke julius title: phyloevolutionary analysis of sars-cov- in nigeria date: - - journal: new microbes new infect doi: . /j.nmni. . sha: doc_id: cord_uid: aejbfk l abstract background phyloepidemiologic approaches have given specific insight to understanding emergence and evolution of infection. knowledge on the outbreak and spread of sars-cov- in nigeria would assist in providing preventive measures to reduce transmission among populations at risk. therefore, this study aimed at investigating the evolution of sars-cov- in nigeria. materials and method a total of complete genomes of sars-cov- were retrieved from the gisaid epiflutm database on march th to investigate its evolution in nigeria. sequences were selected based on the travel history of the patient and the collection date. other sequences were not selected because they were short, contained artefacts, not from original source or had insufficient information. evolutionary history was inferred using maximum likelihood method based on the general time reversible model. phylogenetic tree was constructed to determine the common ancestor of each strain. results the phylogenetic analysis showed the strain in nigeria clustered in a monophyletic clade with a wuhan sublineage. nucleotide alignment also showed a % similarity indicating a common origin of evolution. comparative analysis showed , ( . %) identical sites and . % pairwise identity with the consensus. conclusion the study evidently showed the entire outbreak of covid- infection in nigeria stemmed from a single introduction sharing consensus similarity with the reference sars-cov- human genome from wuhan. preventive measures that can limit the spread of the infection among populations at risk should be implemented. the first confirmed case of covid- in nigeria was announced on february , when an infected traveler from one of the who identified high-risk country; italy arrived by commercial aircraft into lagos. although, the traveler's movement was restricted, another positive case was reported in ewekoro, ogun state, a nigerian citizen who had contact with the italian citizen. despite lockdown in some states and several precautionary measures put in place to prevent and contain the spread of the disease, the nigeria centre for disease control (ncdc) has since then reported over cases of infected patients with deaths in about states (ncdc, ) . incidences of emerging/reemerging viral infections have significantly affected human health despite extraordinary progress in the area of biomedical knowledge (parvez and parveen, ) . the key to understanding this emergence and evolution of novel viruses is subject to knowledge of intricate host-pathogen-environment relationship (susan and julian, ) . understanding the modes of transmission of emerging infectious disease continues to be a key factor in implementing effective public health measures (rota et al., ) . proper tracking of genome sequences has helped to ensure optimal virus diagnostic tests, track and trace the ongoing outbreak and proper identification of potential intervention options . reports have suggested the route of transmission via airborne (booth et al., ) , direct contact, droplet and transmission from mildly ill or asymptomatic individuals (omrani et al., ; paules et al., ) . however, lack of evidence on transmission dynamics can lead to inconsistencies in the isolation guidelines. phyloepidemiologic approaches have given specific insight into understanding emergence and evolution of emerging and reemerging viruses, particularly sars-cov- (avise, ). knowledge on the outbreak and spread of sars-cov- in nigeria would help in providing preventive measures and reduce transmission among populations at risk. hence, this study is aimed at investigating the evolution of sars-cov- in nigeria. a total of complete genome (table ) of novel sars-cov- were retrieved from the gisaid database (https://www.epicov.org) on march th . sequences retrieved include china, italy, france, nigeria, south africa and congo. sequences were selected based on the travel history of the patient and the collection date. the sequences were then aligned to obtain the conserved regions using multiple sequence alignment (msa) with the aid of clustal w on mega x. the sequences were subjected to evolutionary divergence analysis. phylogenetic tree was constructed to determine the common ancestor of each strain using mega . . comparative analysis of strains within clades was performed on geneious prime (https://www.geneious.com/) based on statistical analysis to determine positions in the genomic sequences from nigeria that significantly differ between other strain. the analysis involved nucleotide sequences. the evolutionary history was inferred using maximum likelihood method based on the general time reversible model. the bootstrap consensus tree inferred from replicates is taken to represent the evolutionary history of the taxa analyzed. branches corresponding to partitions reproduced in less than % bootstrap replicates were collapsed. initial tree(s) for the heuristic search were obtained automatically by applying neighbor-join and bionj algorithms to a matrix of pairwise distances estimated using the maximum composite likelihood (mcl) approach, and then selecting the topology with superior log likelihood value. a discrete gamma distribution was used to model evolutionary rate differences among sites ( categories (+g, parameter = . )). the rate variation model allowed for some sites to be evolutionarily invariable ([+i], . % sites). codon positions included were st+ nd+ rd+noncoding. all positions containing gaps and missing data were eliminated. there were a total of positions in the final dataset. the maximum likelihood tree is shown in figure . multiple sequence alignment using clustal w (https://www.ebi.ac.uk/tools/services/rest/muscle), showed all the genomes that formed a clade with the strain from nigeria generally resembled with more than % similarity in the genetic sequence. figures a -g showed consensus similarities and variants between strains from wuhan, china and nigeria, including human sars-cov- human genome. sequences in the alignment were compared to the consensus to identify polymorphism. at each position, the consensus is the allele with frequency greater than %. n ambiguity if no allele exceeds %. knowledge on the transmission chain of an emerging or reemerging virus combined with sequence data provide more insight into explaining occurrence of mutation and spread of infection (folarin et al., ) . in the nigerian covid- outbreak, viewed by itself, nigerian sequence data submitted by okwuraiwe et al., ( ) has provided a clear picture that the entire outbreak stemmed from a single introduction into the country. this is an indication that the first case is an imported case and this has turned to a serious health challenge in the society. along with somewhat close proximity of the sample collection dates to each other, it is possible to reconstruct a transmission chain and infer that patient from nigeria contracted the virus through a patient that got infected with the wuhan strain as seen from the phylogenetic tree. the two strains are in the same clade by sharing the genetic information. the reconstruction can be explained through the findings of parvez and parveen ( ) that the emergence of infectious diseases in naïve regions is dependent on movement of pathogens via trade and travel while local emergence is driven by a combination of environmental and social change . multiple sequence alignment separated the strains studied into distinct clades depending on their divergence with their common ancestor. the strains from wuhan further subdivided the clades into subclades. the strain from nigeria was found in the wuhan subclade together with some strains from congo and france. the strains that formed a monophyletic clade with wuhan subclade resembled with more than % similarity in the genetic sequence. more importantly, the tree confirmed that the outbreak in nigeria was due to a single introduction from china/wuhan through an imported case of an italian. more specifically, the imported sars-cov- strain from nigeria is a descendant of china/wuhan strain as likewise described by zhu et al., ( ) . comparative analysis of the strain from nigeria, strains from wuhan sharing the same clade and the reference human sars-cov- genome was done. results from geneious prime showed all the sequences had , ( . %) identical sites and . % pairwise identity. the strain from nigeria and wuhan strain (wh / ) had more genome sequence similarity as compared with strain wh / . they shared consensus similarity with the reference sars-cov- human genome showing common descendant as observed from other studies by holshue et al., ( ) and arima et al., ( ) . the imported strain into nigeria by the italian shared less than % variant characteristics with wuhan strain wh / . compared with the consensus, the strain from nigeria had gaps, unknowns and point mutations. more than % of these differences were unique to nigeria. summarily, on the basis of the evolutionary analysis, it is evident that human-to-human transmission occurred, hence preventive measures should be adhered to control the spread of the virus. the study evidently showed the entire outbreak of covid- infection in nigeria stemmed from a single introduction sharing consensus similarity with the reference sars-cov- human genome from wuhan. establishment of the phyloevolutionary relationship of the nigerian obtained reference sequence for sars-cov- could benefit biological study of this virus, diagnosis, clinical monitoring and intervention of sars-cov- in nigeria. coronavirus pathogenesis detection of airborne severe acute respiratory syndrome (sars) coronavirus and environmental contamination in sars outbreak units clinical features of patients infected with novel coronavirus in wuhan coronavirus infections-more than just the common cold a family cluster of middle east respiratory syndrome coronavirus infections related to a likely unrecognized asymptomatic or mild case a complete sequence and comparative analysis of a sars-associated virus (isolate bj ) decoding the evolution and transmission of the novel pneumonia coronavirus (sats-cov- ) using whole genome data molecular evolution and phylogenetics mega : molecular evolutionary genetics analysis using maximum likelihood, evolutionary distance, and maximum parsimony methods confidence limits on phylogenies: an approach using the bootstrap ebola virus epidemiology and evolution in nigeria evolution and emergence of pathogenic viruses: past, present and future first african sars-cov- genome sequence from nigerian covid- case genomic characterization and epidemiology of novel coronavirus: implications for virus origins and receptor binding a novel coronavirus from patients with pneumonia in china for the washington state -ncov case investigation team* ( ). first case of novel coronavirus in the united states severe acute respiratory syndrome coronavirus infection among returnees to japan from wuhan, china, . emerging infectious diseases key: cord- -wzctqkd authors: elimian, k. o.; ochu, c. l.; ilori, e.; oladejo, j.; igumbor, e.; steinhardt, l.; wagai, j.; arinze, c.; ukponu, w.; obiekea, c.; aderinola, o.; crawford, e.; olayinka, a.; dan-nwafor, c.; okwor, t.; disu, y.; yinka-ogunleye, a.; kanu, n. e.; olawepo, o. a.; aruna, o.; michael, c. a.; dunkwu, l.; ipadeola, o.; naidoo, d.; umeokonkwo, c. d.; matthias, a.; okunromade, o.; badaru, s.; jinadu, a.; ogunbode, o.; egwuenu, a.; jafiya, a.; dalhat, m.; saleh, f.; ebhodaghe, g. b.; ahumibe, a.; yashe, r. u.; atteh, r.; nwachukwu, w. e.; ezeokafor, c.; olaleye, d.; habib, z.; abdus-salam, i.; pembi, e.; john, d.; okhuarobo, u. j.; assad, h.; gandi, y.; muhammad, b.; nwagwogu, c.; nwadiuto, i.; sulaiman, k.; iwuji, i.; okeji, a.; thliza, s.; fagbemi, s.; usman, r.; mohammed, a. a.; adeola-musa, o.; ishaka, m.; aketemo, u.; kamaldeen, k.; obagha, c. e.; akinyode, a. o.; nguku, p.; mba, n.; ihekweazu, c. title: descriptive epidemiology of coronavirus disease in nigeria, february– june date: - - journal: epidemiol infect doi: . /s x sha: doc_id: cord_uid: wzctqkd the objective of this study was to describe the epidemiology of covid- in nigeria with a view of generating evidence to enhance planning and response strategies. a national surveillance dataset between february and june was retrospectively analysed, with confirmatory testing for covid- done by real-time polymerase chain reaction (rt-pcr). the primary outcomes were cumulative incidence (ci) and case fatality (cf). a total of persons ( % of total ) had complete records of rt-pcr test across states and the federal capital territory, ( . %) of whom were confirmed covid- cases. of those confirmed cases, ( . %) had complete records of clinical outcome (alive or dead), ( . %) of which died. the overall ci and cf were . per population and . %, respectively. the highest proportion of covid- cases and deaths were recorded in persons aged – years ( . %) and – years ( . %), respectively; and males accounted for a higher proportion of confirmed cases ( . %) and deaths ( . %). sixty-six per cent of confirmed covid- cases were asymptomatic at diagnosis. in conclusion, this paper has provided an insight into the early epidemiology of covid- in nigeria, which could be useful for contextualising public health planning. on december , a cluster of cases of pneumonia of unknown aetiology was detected in wuhan city, hubei province, china [ ] . on january , the chinese authorities identified and announced a novel type of coronavirus as the cause of the disease [ ] . on january , the world health organization (who) declared the -ncov outbreak a public health emergency of international concern [ ] and a few days later announced the official name of the virus as severe acute respiratory syndrome coronavirus (sars-cov- ) and the disease as coronavirus disease (covid- ) [ ] . covid- was declared a pandemic on march by the who. the first case of covid- in nigeria was confirmed on february . the case was a -year old italian citizen who arrived nigeria through the murtala mohammed international airport, lagos, on a flight via milan, italy [ ] . this index case led to the activation of covid- public health emergency operation centers (pheoc) at national and sub-national levels, with associated active case finding via contact tracing. by march , contacts were linked to this index case [ ] , out of which ( . %) were under follow-up, with one contact confirmed positive [ ] . the -day follow-up for contacts of the index case ended on march . during this period, two additional unlinked cases were reported in nigeria. in addition, suspected cases were identified across seven states in nigeria namely the federal capital territory (fct), edo, kano, lagos, ogun, rivers and yobe [ ] . since the confirmation of the first covid- case in nigeria, cases and deaths have risen steadily in the country, although the government has implemented public health interventionse.g. advocacy for physical distancing, complete and partial lockdown, and ban on large public gatherings including at churches and mosquesto contain or mitigate spread. as of june , (out of ) states, plus the fct, have reported at least one confirmed covid- case. a descriptive analysis of the clinical characteristics, treatment modalities and outcomes of the first covid- patients admitted to mainland hospital in lagos state, nigeria, found that two-thirds of patients were male, and the mean age was . years [ ] . this early analysis however is insufficient to provide a national overview of covid- epidemiology in nigeria. the nigeria centre for disease control (ncdc) coordinates the public health response to covid- in the country. through ncdc's surveillance and laboratory network as well as coordination of state pheocs, epidemiological information on covid- cases are captured into a real-time networked platform called surveillance outbreak response management and analysis system (sormas). this forms the basis for the release of daily situation reports for covid- on ncdc covid- microsite [ ] . by june, thousands of individual records with laboratory diagnosis contained on sormas offered opportunities to expand and explore country-specific epidemiologic and clinical characteristics of covid- from the onset of the outbreak. this study aims to provide the initial descriptive epidemiology of covid- in nigeria, with emphasis on the disease magnitude and patterns in terms of person, place and time. we conducted a retrospective analysis of nigeria surveillance data between february and june . nigeria is administratively divided into states plus the fct, which are zoned across six geopolitical areas: south-south; south-west; south-east; north-east; north-west and north-central. during the study period, states plus fct had reported confirmed covid- cases; all states were actively monitoring for cases through the integrated disease surveillance and response system (idsr) system [ ] . sormas, an open-source real-time electronic health surveillance database, was the primary data source for this study. in , ncdc adopted sormas as its primary digital surveillance platform for implementing the idsr system [ ] , and customised it for the surveillance of priority diseases of public health importance in nigeria. as part of the country's preparedness activities, a covid- module was developed and added to sormas in january . all the surveillance data generated through sormas is owned by ncdc, processed and stored in a central server at the ncdc headquarters in abuja, nigeria. the study population was persons investigated for sars-cov- infection and captured on sormas during the study period. samples were collected from suspect cases in line with the ncdc case definitions (which were in turn derived from who case definitions) in table [ ] . however, these guidelines were not strictly adhered to as samples were also collected from some asymptomatic cases and contacts of cases. trained healthcare personnel (and rapid response team members) investigated suspected covid- cases, completed a detailed case investigation form (cif) and collected a minimum of one nasopharyngeal or nasal swab, and one oropharyngeal swab using synthetic fibre swabs with plastic shafts. collected specimens were triplepackaged and aseptically transported in viral transport media, under appropriate temperature conditions ( - °c) to a designated ncdc-certified laboratory in the country, usually based on proximity. laboratory diagnosis of covid- was done by residential setting c residential setting of each person tested for covid- was based on the population size and administrative/ legal criteria for the reporting local government areas (lga) as recorded by field staff, in line with common classification of urban and rural classification in nigeria [ ] . for example, an lga was classified as urban if 'any one' of the following criteria was met: ( ) state capital; ( ) an estimated population size of ⩾ ; ( ) > % of its population is engaged in non-agricultural occupations; ( ) availability of infrastructure, good transportation system and a broad array of economic, social and recreational activities. health facility health facility refers to the type of facility each person tested for covid- visited prior to diagnosis or was identified for diagnosis. because it was listed on sormas without specific categorisation into health facility type, we utilised the nigeria health facility registry (hfr) of the federal ministry of health [ ] to identify each health facility type so as to minimise misclassification errors. the hfr has details of all the registered health facilities in nigeria including the state, lga, facility level (primary, secondary and tertiary) and ownership type (private and public). overall, each health facility was defined either as primary, secondary, or tertiary facility; health facilities that could not be identified in the registry were treated as unknown. education completed classified as a categorical variable in line with the nigerian educational system: no formal education; nursery/ primary; secondary and tertiary/post-secondary. however, given the peculiar nature of the almajiranci/ quranic educational system in nigeria, they were classified under a separate category termed 'alternative' education. classified as a categorical variable as follows: pupil/student; child; housewife; trader/business; health professional (e.g. nurse, clinician, laboratorian etc.); animal-related work (e.g. butcher and hunter); farmer; religious/traditional leaders; transporter and other. travel history classified as local, international and no travel in the last days prior to diagnosis. clinical signs and symptoms defined relative to days before sample collection and classified as binary: yes/no. examples of clinical variables include fever (defined as an axillary temperature of . °c or higher), cough, difficulty breathing, diarrhoea, headache among others. quarantine location defined as a binary variable: formal institution (e.g. health facility) and informal institution (e.g. home). time from symptom onset to diagnosis defined as the time difference between the dates of sample collection and self-reported symptom onset among symptomatic covid- cases only. (continued ) real-time polymerase chain reaction (rt-pcr) in accordance with the who interim guidelines [ ] . in addition to clinical samples, information on patients' sociodemographic characteristics, signs and symptoms in the days prior to diagnosis, laboratory findings and clinical outcome as detailed in the national cif was captured on sormas. surveillance and laboratory data were submitted by trained data collectors (i.e. healthcare personnel) in real time to the ncdc through the sormas platform (configured on mobile devices (e.g. tablets and smartphones) and laptops) by each reporting state epidemiologist and testing laboratory, respectively. all laboratory-confirmed covid- cases were managed according to the ncdc case management protocol [ ] , while adherence to infection prevention and control measures for both health workers and patient was ensured. testing for covid- during this study period is free of charge in nigeria. de-identified data were retrieved from sormas. covid- classifications (suspect, probable and confirmed case) were entered by trained data collectors as per the ncdc case definitions [ ] . data management and definitions of key study variables are presented in table . the missing indicator approach was used to address missing data. the primary outcome variables for this study were cumulative incidence (ci) and case fatality (cf). ci was defined as the ratio of covid- cases in a defined area to the estimated population of that area. based on a national average growth rate of . %, ci for each reporting state was calculated using the projected nigerian population of from the national census and was multiplied by for ease of interpretation. cf was defined as the proportion of persons diagnosed with covid- who died during the study period, expressed as a percentage (%). both ci and cf were calculated for nigeria and for each state separately. binary/categorical variables were described using frequencies and percentages (%), normally distributed continuous variables by means and standard deviations (s.d.), and non-normally distributed continuous variables by medians and interquartile ranges (iqr). pearson χ test was used to assess how the sociodemographic and clinical characteristics between covid- cases (confirmed cases vs. non-cases) and clinical outcome (alive vs. dead). a p-value of < . was considered statistically significant. all statistical analyses were carried out in stata version (stata corp. lp, college station, tx, united states of america). the report of this study was structured in accordance with the strobe statement. the study protocol was approved by the nigeria national health research ethics committee (nhrec/ / / - / / ). between february and june , records were entered in the covid- sormas database in nigeria, these were classified as follows: suspected cases ( . %), probable cases ( . %), confirmed cases ( . %), non-cases ( . %) and non-classified cases ( . %). this study focuses on individuals with definitive diagnostic classification ( ): confirmed cases (n = ) and non-cases (n = ). the daily incidence of cases is shown in the epicurve in figure . males ( . %) constituted a higher proportion of confirmed covid- cases than females ( . %) (fig. ) . the mean (s.d.) age of confirmed covid- cases was . ( . ) years, with the highest proportion of these cases recorded among persons aged - years ( . %) and - years ( . %) ( table ) . despite the high proportion of confirmed cases with missing information on education ( . %), . % reported completing tertiary time from sample collection to arrival in the laboratory defined as the time difference between the dates of sample arrival in the laboratory and sample collection; it was treated as a continuous variable. defined as the time difference between sample collection and the date diagnostic test was ready (including sample collection, transportation, collection and diagnosis at the laboratory); it was also treated as a continuous variable. a initially, some of the returnees from abroad were tested for covid- even in the absence of symptoms. b for confirmed asymptomatic cases, period of contact was measured as the days before, through the days after the date on which the sample was taken which led to confirmation; for symptomatic cases, it was presumably days before symptom onset through days after. c for more information on the criteria for urban/rural classification in nigeria, see [ ] . d all negative values following the subtraction of date variables were dropped. education, followed by secondary school certificate holders at . %. for confirmed cases with occupation information available, . % were healthcare workers, while pupil/students and traders accounted for . % each. the proportion of confirmed cases who reported history of travel days prior to diagnosis was generally low, with local and international travels at . % and . %, respectively. sixty-six per cent ( / ) of confirmed covid- cases were asymptomatic in the days prior to diagnosis. among confirmed covid- cases with symptoms (n = ; . %), fever ( . %) and cough ( . %) were the most common signs and symptoms reported. other symptoms commonly reported among confirmed covid- cases were runny nose ( . %), sore throat ( . %), difficulty in breathing ( . %), headache ( . %), diarrhoea ( . %), nausea ( . %), vomiting ( . %) table ). of these, cough ( . %), fever ( . %) and difficulty in breathing ( . %) were the most commonly recorded signs and symptoms. other common symptoms recorded at diagnosis were sore throat ( . %), runny nose ( . ) and vomiting ( . %). cumulative incidence of covid- and case fatality in nigeria, february- june the overall ci of covid- infection and cf in nigeria during the study period was . per population and . %, respectively (table ). lagos state ( . per ), followed by the fct ( . per ), recorded the highest ci in nigeria during this study period. other states with ci higher than the national figure include edo ( . per ), kano ( . per ), ogun ( . per ) and gombe ( . per ). regarding cf across the various figure . b percentages in some instances may be greater than . % due to rounding up. c only for symptomatic confirmed covid- cases with records of clinical outcome: survivor (n = ), dead (n = ), and total (n = ). d total records were used for the assessment of temperature. †p-value < . ; ‡ p-value < . ; ns = p-value not statistically significant (i.e. > . ). Φ: p-value from t-test was < . ; mean difference was . years. we have provided a description of the first national epidemiology of covid- cases and associated clinical features and outcomes for nigeria. there were confirmed covid- cases and non-cases in states plus the fct in nigeria between february and june . during this period, there were deaths, a ci of . per and a cf of . % overall. after south africa, nigeria is the second most-affected african country in terms of recorded confirmed covid- cases and death as of june [ ] . however, the ci of covid- in nigeria during the study period, at . per population, is substantially lower than in some non-african countries at a similar stage in their epidemic. for example, about three months after the first confirmed case in the united states, ci was ⋅ per population, far more than that of nigeria's; with minnesota, the state with the lowest ci, having a ci of . per population [ ] . additionally, many european countries reached a ci of at least . confirmed cases per population over a period of less than month [ ] . a possible reason for lower ci in nigeria could be due to a relatively low testing capacity in the country as compared to the us and european countries. there was substantial variability in covid- incidence among the states in nigeria. the heterogeneity in cis within nigeria could be attributable, in part, to international travels as indicated by the figures recorded by lagos state ( . per ) and the fct ( . per ) with the two major international airports in the country. another possible explanation might be due to variations in the estimated population of states in nigeria, with smaller population recording a higher ci and vice-versa. for example, ekiti state ( population) and enugu state ( population) each recorded confirmed covid- cases during this study period; but the latter recorded a lower ci ( . per population) than the former ( . per ). moreover, all the nigerian states did not have a similar testing capacity during the study period, and this might have contributed to the observed findings in terms of the numerator figures for calculating cis. similarly, the cf of . % in this study is lower than several other countries which have been hard hit by the covid- pandemic. there is a wide range of cfs among non-african countries (from . % in singapore to . % in belgium [ ] ) and in african countries (from . % in uganda to . % in chad) during this study period [ ] . nigeria's observed cf of . % is on the lower end of the range reported outside and within africa, but higher than the . % ( deaths/ confirmed cases) recorded for the entire africa as of june [ ] . the variation in cf in nigeria could be an indication of varying health system capacity and preparedness across the country. an unpublished study indicates that lagos statewith the highest ci but a cf of . %invested substantially in case management of covid- patients as part of its preparedness activities. the overall cf in nigeria could be partly due to its much younger population compared to the united states and most countries in europe [ ] ; similar trends in deaths by age from covid- have been reported in china [ ] . just as cases are potentially underestimated due to inadequate testing, it is likely that deaths from covid- are also underestimated, especially in places like kano, which reported significant increases in deaths in april [ ] . in contrast to deaths from covid- , a higher proportion of covid- cases was recorded among economically active age groups, suggesting potential role of socio-economic or workrelated activities rather than immunological capacity. children under years of age and those aged - years, respectively, accounted for . % and . % of confirmed covid- cases in this study. these findings are comparable to those from a recent global systematic review [ ] . although it remains unclear why children are less affected by covid- than older individuals, evidence suggests differences in immune system function [ ] . the higher infection rate among males in this study corresponds to evidence reported in the who african region, where males in the - and - age groups accounted for % of recorded cases [ ] . outside africa, early findings of the clinical characteristics of confirmed covid- cases in wuhan, china, reported males to have accounted for ( . %) of the cases [ ] . a study in italy also reported male preponderance [ ] . a combination of genetic and physiological factors has been hypothesised as possible explanations for the potential male bias. for example, the wider distribution of sars-cov- cellular receptor, angiotensin-converting enzyme (ace- ), in male over females has been postulated [ ] . in a patriarchal system such as seen in nigeria, men are more likely to engage in economic activities outside of the household and potentially become more exposed to sars-cov- infection than women. while this may be more feasible during a controlled economy, such as that seen during the suspension of non-essential economic activities in the early phase of covid- outbreak in nigeria, it may not be applicable when socio-economic activities are functional. this is because women are increasingly partaking in the workforce in nigeria, such that the traditional trends of 'male breadwinner and female family support' are fast eroding [ ] . the median length of stay of patients with covid- in hospital in this study was days, which is within the range outside of china ( - days), but comparatively lower than that from china ( - days) [ ] . in general, differences in the length of hospital stay may be attributable to variations in criteria for admission and discharge across different countries as well as timing within the pandemic [ ] . early diagnosis is fundamental for effective management of covid- cases; thus, a median turnaround time of ( - ) days for laboratory diagnosis as noted in the current study seems impressive, and possibly an indication of ongoing measures being championed by the ncdc to strengthen molecular diagnostic capacity in nigeria. however, we lacked information on when laboratory test was received by a covid- suspected case, as turnaround time only included the time from sample collection to availability of result. the symptomatic status of confirmed covid- cases in this analysis is noteworthy, as over half of them were asymptomatic at testing. a scoping review of the literature found that between % and % of people testing positive for sars-cov- may be asymptomatic [ ] , placing the % in the current study closer to the maximum range. it is possible that the case investigation approach adopted during testing might have underestimated symptoms: patients were initially asked whether they were symptomatic and probed about individual symptoms only if they answered in the affirmative. stigma associated with covid- in nigeria might contribute to people not reporting symptoms when they get tested [ ] . furthermore, it is possible for asymptomatic status at diagnosis to change in the course of an illness, in which case such persons could be better classified as presymptomatic cases, so the proportion of truly asymptomatic cases cannot be described by these data. nevertheless, this scenario could pose a challenge to community surveillance activities and implementation of public health interventions (e.g. quarantine and isolation). thus, the possibility of covid- transmission by asymptomatic cases in nigeria needs to be explored and addressed, both in terms of research and community risk communication activities. the most common signs and symptoms among symptomatic confirmed covid- cases in the days prior to diagnosis were fever ( . %) and cough ( . %). this trend is similar to that recorded in a recent systematic review of the literature for china [ ] ; however, while fatigue was the third most frequently recorded symptom in china, its frequency was low in our study at . %. similarly, cough, fever and difficulty in breathing, in that order, were the most commonly recorded symptoms at diagnosis among persons who died from covid- infection. the common occurrence of difficulty in breathing in deceased patients has been identified as a major driver of adverse clinical outcomes among covid- patients [ ] . although relatively small in proportion due to late recording during the study period, loss of smell and loss of taste among confirmed covid- cases in this study are consistent with available evidence [ ] . however, being a descriptive study, these data do not have the capacity to establish a causal association between observed clinical symptoms and covid- infection or death. thus, a follow-up study aimed at exploring these associations is recommended. it is also worth noting that the fever which is one of the common symptoms noted in this study is often common in endemic febrile illnesses in nigeria including malaria, lassa fever and yellow fever. as such, in the case of a co-infection, misclassification of illnesses is likely if symptoms alone are used for covid- case definitions [ ] . the symptomatic and geographic convergence of covid- and common febrile diseases in nigeria therefore requires continuous strengthening of definitive diagnostic approaches in the country. about % of covid- infections occurred in healthcare workers during this study period. covid- infection among health workers is of prominent public health importance as it could potentially enhance disease transmission [ ] and further weaken a health system that already struggles with insufficient human resources for health. this study has provided the first national epidemiological evidence on covid- in nigeria, necessary for public health planning and health system strengthening. however, this study is limited by the substantial proportion of missing data within some of the sociodemographic (e.g. residential setting and health facility) and clinical (e.g. malaise, pharyngeal exudate, rapid breathing, loss of smell and taste) variables studied. the late addition of loss of smell and taste to the cif in nigeria may partly explain why data recorders were not accustomed to capturing them. the high proportion of missing data on some key indicators has prompted a systemic effort to improve the quality of sormas data, and a dedicated data quality improvement project (dqip) was initiated in april to improve completeness of key variables to above %. in conclusion, this study has provided an early insight into the epidemiology of covid- in nigeria. evidence from this study, such as the high proportion of cases among the active age group and high proportion of asymptomatic cases at diagnosis, will be useful for policymakers and stakeholders in the health and other sectors in contextualising public health planning and response as well as for scientific activities in the country. such measures could include intensifying npis at work and commercial places where this age group is 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covid- pandemic -a systematic review coronavirus disease (covid- ) in children -what we know so far and what we do not? clinical features of patients infected with novel coronavirus in wuhan baseline characteristics and outcomes of patients infected with sars-cov- admitted to icus of the lombardy region emerging markers in cardiovascular disease: where does angiotensin-converting enzyme fit in? turbulent but i must endure in silence: female breadwinners and survival in southwestern nigeria covid- length of hospital stay: a systematic review and data synthesis covid- : what proportion are asymptomatic? cebm world health organization ( ) social stigma threatens covid- response but patients heal faster with everyone's support. world health organization regional office for africa clinical characteristics of coronavirus disease (covid- ) in china: a systematic review and meta-analysis clinical characteristics of coronavirus disease in china the role of self-reported smell and taste disorders in suspected covid- covid- and malaria: a symptom screening challenge for malaria endemic countries covid- and infection in healthcare workers: an emerging problem acknowledgement. we wish to thank all the nigerian frontline health personnel for the contribution to the collection of the data used for this study. the leadership and coordination of all the state commissioners for health, epidemiologists and disease notification and surveillance officers are very much appreciated. last but not least, we are grateful to colleagues who provided technical and administrative support for this manuscript. key: cord- - wxa authors: lawal, olanrewaju; nwegbu, chidozie title: movement and risk perception: evidence from spatial analysis of mobile phone-based mobility during the covid- lockdown, nigeria date: - - journal: geojournal doi: . /s - - -z sha: doc_id: cord_uid: wxa the emergence of covid- across the globe prompted many countries to institute total lockdown or other models of mobility restrictions to mitigate the spread of the disease. on march th, nigeria instituted a nationwide lockdown. it is pertinent to understand the pattern created by this lockdown. this could offer insights into how people perceive the hazard and the level of compliance across the states in nigeria. mobile phone-based mobility data and the number of new cases from the beginning to the end of the lockdown were utilised. the study examines space-time trends across different place categories at the state level. place categories witnessed mobility reduction as high as %, %, %, %, % for retail and recreation (rtrc), grocery and pharmacy (grph), park, and transport hubs (trst) respectively. most states recorded mobility uptrend towards workplace, retail and recreational areas. multiple correspondence analysis (mca) identified two dimensions from the space-time trends. the first dimension (d ) accounted for % of the variance. examination of the object scores from the mca showed that there are two classes–two risk perception groups. the pattern of mobility recorded shows that there is a variation in mobility restriction compliance across the states. the trend groupings identified captured an aspect of risk perception within each state. thus, pointing to difference in levels of risk acceptance. with the level of misinformation currently being experienced worldwide, concerted efforts should be made on improving risk perception to prevent the re-emergence of the disease. in december , the news of the outbreak of an emerging viral infection broke in the city of wuhan, china. the world health organisation (who) initially declared the outbreak a public health emergency of international concern and later upgraded it to a global pandemic, following its rapid diffusion to several countries. currently, the number of global covid- cases has surpassed the million mark while deaths arising from these cases are over , . this has never been seen in contemporary times. it is in fact unlike, the previous outbreak of severe acute respiratory syndrome (sars) of and ebola in west africa of . covid- , within a short period, grew from a local event to a pandemic affecting many people and places. this prompted many countries to institute total lockdown or other models of mobility restrictions to mitigate the spread of the disease. on march th the federal government of nigeria instituted a nationwide lockdown to mitigate the spread of covid- . this lockdown offers one of the most potent tools at mitigating the spread, however, it also presents a serious problem. with the instituted restriction and the induced mobility reduction due to fear and apprehension, the effect on various aspects of the society is going to be disparate over space and across people. thus, it is important to examine the pattern of this mobility restriction across the country, thereby offering insights into the potential impact across the country. in this context, the study examined variation in human mobility during the lockdown period across the country. therefore, providing an understanding of the pattern of mobility restriction compliance and the indication this provides for risk perception during this period. this understanding can provide baseline information for the management of future infectious disease emergencies, response and recovery (social and economic) planning, and evidence to support post-pandemic social and economic development. devastating pandemics have existed since a.d when the world experienced the bubonic plague that wiped out - million people in one year (morony ) . it was one of the worst outbreaks the world experienced, and it lasted for another years, sweeping throughout the mediterranean world until ce. in the year of - , the black plague killed more than million people in the middle eastern lands of china, india, as well as europe (cohn ) . the spanish flu pandemic, caused by an h n virus with genes of avian origin, killed over million people in one year in (cohn ) . in america, , deaths were recorded; , , in sub-saharan africa, and , in nigeria, out of a population of million in less than months (ohadike ) . human mobility facilitates infectious disease transmission. for covid- , rapid diffusion has been attributed to domestic and international travel within china and other countries. for instance, domestic and international travelers from wuhan, china facilitated the spread, particularly during the annual lunar new year celebrations. as travel restrictions were implemented, this effectively slowed down the spread in the early days of the outbreak (chinazzi et al. ; kraemer et al. ) . the recent cases in new zealand where travelers from the uk were implicated in new cases recorded in new zealand with no new cases for days (graham-mclay, ) highlight the importance of human mobility for infectious disease spread. from the foregoing, the relevance of mobility in the spread of infectious diseases is apparent. there is a clear indication that there is going to be another eid in the future, therefore, there is a need to gather insights from the current pandemic on what worked, failed, or need to be improved upon in managing the pandemic. most especially, the compliance of the mobility restriction and potentially the perception it can indicate needs to be thoroughly explored. analyses of spatial patterns and distribution of human activities and natural phenomena are often leveraged for understanding spatial interaction and consequently spread of ideas knowledge and in this context, disease. identification of the pattern of human mobility and the number of new covid- cases is important. this offers an opportunity to examine the effect of the mobility restrictions and thereby design ways to ensure the effectiveness of measures to curtail the spread of covid- . human activities and habitation are directly impacted by location and the opportunity offered by transportation-human mobility. this interrelationship and dependencies often lead to the increasing agglomeration of businesses, industries, and infections/diseases at specific locations (e.g., established urban centres). similarly, there is a tendency for the segregation of people with a similar culture, tradition, behavior, social class, etc. across different regions and locations. literature review covid- found its way into nigeria through an infected italian national who has work engagements in the country when he touched down in lagos state on february , (ncdc ). being the third zoonotic coronavirus outbreak of this century (xie and chen ) with infection and mortality rate seemingly higher than those of the other two-mers and sars, its perilous nature cannot be disregarded (kang et al. ) . this necessitated the nationwide lockdown that was declared by the federal government as a precautionary measure done by countries world over. nigeria took cognizance of the lockdown's effectiveness when the third confirmed case, who was duly notified by the contact tracing team, self-quarantined and later became symptomatic, was cautiously isolated and successfully treated (chia and oyeniran ) thereby mitigating community transmission. by and large, the hardiness of public health systems of countries plagued by the virus can have a significant influence on the case and fatality figures (paintsil ) . despite this, the restriction of movement remains imperative in curtailing the spread of the virus. human mobility has been known to be very important in spreading infectious diseases. balcan et al. ( ) studied the interplay between short-scale commuting flows and long-range air traffic in shaping the spatiotemporal pattern of the global epidemic. their model showed that despite commuting flow being one order of magnitude larger than long-range air traffic, the spatiotemporal pattern of infectious disease spread was mainly determined by airline network and traffic. furthermore, short-range movements were found to be more important for synchronization of the spreading across subpopulations which are weakly connected by air transportation. they found that short-range mobility has an impact on the definition of the subpopulation infection hierarchy. riley ( ) reviewed studies on four different diseases (measles, foot and mouth disease, pandemic influenza, and smallpox). the work showed that the major determinant of the geographic spread and emergence of infectious diseases (and reoccurrence) are disease-relevant human interactions (contact with infected surfaces and person-to-person interaction) and mobility across multiple spatial scales. thus, at the onset of the outbreak, or re-emergence of the pathogen, disease incidence will most likely occur in spatial clusters, as such if containment is activated, it is possible to predict the spread of disease. jones et al. ( ) showed that from to , emerging infectious diseases, showed a nonrandom global pattern, most dominated by zoonoses ( % of the eid and notable increases between and ) while about % of these originates from wildlife. by controlling for spatial reporting bias within countries, the study found that human population density and wildlife host species richness are significant predictors of the emergence of zoonotic eids. in the case of zoonotic eids from the nonwildlife hosts, human population density, growth rate, latitude, and rainfall were found to be significant predictors. eid emergence caused by drug resistance has population density and growth as well as latitude and rainfall as significant predictors. the population density was the only significant predictor of vectorborne eid emergence. the origins eid were found to be significantly correlated with socio-economic, environmental, and ecological factors. contrary to previous analyses indicating pathogen species richness increase towards the equator, the study indicated that eid events are mostly concentrated around °and °north and - °south. adepoju and soladoye ( ) held the view that for a vivid comprehension of the epidemic's transmission patterns, geographical perspective must be considered. moreover, being that social sciences provide comprehensive and robust insights when researching the effects of infectious disease outbreaks on communities and populations socially, contextually, and behaviorally (la et al. ) , it is crucial to incorporate them in epidemiology. based on this, the perception of the disease's threats and the compliance level by the populace can be scientifically deduced. for covid- pandemic awareness measures, olapegba et al. ( ) utilized descriptive statistics to depict the risk perception and precautionary health behaviors as observed by nigerians. the results of their findings showed that out of respondents, . % believed there is a high chance of them contracting the virus in nigeria, . % think they cannot get infected while . % were undecided. on some of the precautionary health behaviors, up to . % indicated their readiness to self-isolate when required to, . % think otherwise while . % were indifferent. also, % abstained from going to public places, . % opposed to it while . % were on either side. however, on the use of face mask, . % were willing to comply, . % found it discomforting and . % were undecided. anchored on perception and impact of the pandemic in nigeria, akintuyi et al. ( ) in their work revealed that of the respondents, % acknowledged the presence of the covid- virus in nigeria while % thought it was a hoax. on the other hand, the movement restriction order hugely affected . % of the respondents and their livelihood while . % did not feel the effect. in their paper, taiwo and olumoyegun ( ) demonstrated how distance played a role in the transmission of the virus in nigeria-from lagos to other state capitals. categorizing the states with international airports, domestic airports, and no airports accordingly, the results showed high variations in the reported case figures for states with international airports as against those states with domestic or no airports. also, they noted that there was a statistically significant difference between the three groups. abdullahi and abdulkadir ( ) analyzed the role of temperature in the dispersion of the covid- virus across geopolitical regions and states in nigeria with the aid of linear trend surface analytical tools. their research further established that no significant relationship exists between varying temperatures across states and covid- spread. in assessing compliance with the mandatory stayhome order and its attendant socio-economic effects on the populace, olabamiji and ajala ( ) employed online questionnaires in acquiring data. with respondents, while . % could neither go to work nor do anything productive from home, % were not fully engaged in their work and . % did not disclose their work status during the lockdown. on the part of its effects, . % lived on their savings, % borrowed funds, . % on salary, . % depended on farm produce, . % each on gifts from relatives and palliatives respectively while . % benefitted from their businesses. addie et al. ( ) portrayed states ranked in order of their vulnerability to covid- in nigeria. with the aid of select population-based indicators, they performed a stepwise regression analysis on their data to point out different vulnerability levels. results obtained showed kebbi state was the most vulnerable with . points followed by zamfara at . points and then sokoto at . points. based on geopolitical zones, north west ranked as the most vulnerable with north east in second place and north central in third place. in a similar vein, fasona ( ) utilized some core transmission drivers to analyze and create maps, at the state level, to show their respective vulnerability level to the virus. the results indicated that states (lagos, fct, kaduna, katsina, kano, rivers, and oyo) had very high vulnerability, states had high vulnerability while that of states stood at medium vulnerability. in modeling covid- transmission predictively in nigeria as was influenced by traveling history and contacts, ogundokun et al. ( ) , using the number of cases data from the ncdc, applied the ordinary least squares estimator in generating a regression analysis model which showed both the daily effects in travel history and contact rates on confirmed cases. between the months of march and may , the results indicated a . % reduction in covid- cases in comparison to the expected figures as a result of the travel ban on both local and international flights. they also noted that the populace chances of contracting the virus due to their travel history and contacts they made increased by % and % respectively. nigeria as a federation has states and abuja as the federal capital territory (fct)- fig. . the states are further divided into lga spread over an area of , square kilometres, including about , km of water. the work of lawal and anyiam ( ) provides more details about the study area. mobility data were sourced from the google covid- mobility report (google llc furthermore, the sum of the place categories except the residential were summed and explored. data for the new cases were collated from the humanitarian data exchange website, under the covid- pandemic initiative (backup rural ). to capture the distribution of mobility across the study area, choropleths of median mobility were produced. these were produced using spss (ibm ) , for each of the place categories as well as the aggregate of all the place categories (except the residential categories). space-time analyses of aggregated mobility values were carried out within a geographic information system (gis)-arcgis (esri ). this was done to identify the spatio-temporal clusters of mobility across the lockdown period. trends were discerned across the study area over time using the mann-kendal test (kendall and gibbons ; mann ) . this approach is a rank correlation analysis for the bin count (sum of value) and their respective time sequence. each period is compared to the one before it and an increase results in a value of ? (an increase over time) while a decrease results in (a decrease over time) and a tie result in zero (no trend over time). this was computed for each time slice (day) and the sum of this was computed for each of the spatial units (states). these sums were compared to the expected sum of zero (no trend over time) and using the variance of the values, as well as number of ties and the number of time slices, as the observed is compared to the expected to deduce the z score and a p-value. the trends across each sector were examined at weekly ( ) intervals for each state. trend categories identified from the space-time analysis were subjected to multiple correspondence analysis. this was carried out to group quantify the nominal categories by assigning numerical values to each state and grouping them. this analysis does maximise intergroup differences and minimise intragroup differences, thus creating homogenous groups based on the trend of mobility across each state. the trend of mobility for the six place categories was utilised for this analysis. the initial analysis assumed there are two dimensions. an equal weight of was given to each of the variables as there was no scientific justification to assign unequal weight. for discretisation, the multiplication approach was adopted. this comprises of standardisation of values, multiplication fig. the nigerian states and the neighbouring countries by , rounding off, the addition of constant value (to ensure the lowest value is ). object principal normalisation method was applied as this optimises for the distance between objects thus, ensuring that within group similarity are minimise and between group are maximised. the results of this analysis would provide insight into the potential grouping of risk perception based on the mobility trend. place category aggregated mobility trend for the retail and recreation category (fig. a) , sokoto showed median mobility of zero while some states experienced an increase (compared to baseline) mobility for this place category. zamfara showed a very high increase in mobility (median %). kebbi, borno, yobe, gombe, and ebonyi represents a group of state with relative median mobility decline of less than % (relative to baseline). the greatest decline (ranging between and %) in mobility were recorded across various states (ekiti, kaduna, lagos, fct, and edo) spanning various regions of the country. the largest decline was recorded for edo state. generally, most of the states recorded median mobility decline ranging between % and %. in the parks place category (fig. b) , gombe state is the only state with the increased median mobility across the country during the period under investigation. abia, adamawa, jigawa, ebonyi, bayelsa, and bauchi state showed a slight decline in mobility (relative to baseline) ranging between % and %. fct, benue, ekiti, and lagos witnessed the highest decline ranging between % and %. while the remaining states recorded declines between % and %. for this place category, all the states witnessed a decline relative to their baselines for the period under consideration (fig. c) . the lowest decline was recorded for yobe state ( %) and the greatest was workplaces; and f residential recorded for zamfara state ( %), this was followed by ekiti ( %), and kano ( %). most of the states ( %) recorded a relative decline ranging between % and %. this place category witnessed a relatively high mobility decline ranging between and (fig. d) . three states namely ebonyi, nasarawa, and niger recorded a median mobility value indicating a slight increase relative to their baseline values ( %- %). kebbi and kogi showed a slight decline of % while % of the geographic units considered recorded decline ranging between % and %. six states (including the fct) showed a considerably high level of decrease in mobility with a median change from baseline ranging between % for the fct and % for rivers state. zamfara recorded a median increase of % relative to the baseline mobility for the workplaces category (fig. e) . this is the only outlier state for this category (i.e. it bucks the trend of declining mobility for this category). states like yobe, bauchi, katsina, kogi, and adamawa recorded a slight decline median values raging between % and %. most of the states recorded a decline c % while four geographic units-kwara, fct, kano, and lagos recorded a decline above %. this place category witnessed a high mobility increase, with a relative percentage increase ranging between and % (fig. f) . the largest increase is recorded for lagos (the epicentre of the covid- infection in nigeria) while the lowest (no change in mobility) is recorded for kogi (one of the last state to record a covid- case). this is a wide variation in the increase across different states and regions, with about % of the state recording % or more median mobility increase for this place category. mobility values for all the place categories except residential were summed to indicate mobility across places where infection may be spreading (unsafe). this term unsafe is relative in this context since there is a possibility that mobility towards residential areas could also spread the disease (community spread). the median mobility (fig. ) for these unsafe categories showed a general reduction in mobility with the lowest mobility decline recorded for ebonyi state ( . ) while the greatest decline was recorded for fct ( ). this computation gave a cumulative overview of how mobility varied for these place categories across states. out of the states and fct showed a cumulative decline above , while only three states (ebonyi, kebbi, and zamfara) recorded a cumulative decline of less than . from the values, four major hotspots for the decline could be identified around lagos, ekiti, fct (kaduna, kano) as well as akwa-ibom state. examination of the weekly aggregated mobility for the retail and recreation category showed that states exhibited no statistically significant trend (fig. a) . five of these states spanned across the north-west and north-eastern part of the country while the other two can be found in the south (bayelsa) and the middle belt (taraba). three states showed a statistically fig. cumulative mobility across unsafe place categories significant downtrend for mobility for this place category, with all of them in the northern part of the country. all other states displayed an uptrend in mobility for this place category. for parks, most of the states showed no statistically significant trend (fig. b) . however, bayelsa and abia states showed a downward trend in mobility for the category. all the other states (in the southern part and the middle belt of the country) showed an upward trend in mobility. yobe and gombe states recorded a declining trend for mobility in the grocery and pharmacy place category (fig. c) . twelve states across the north-western, north-eastern, middle belt, and southern (bayelsa and cross river) parts of the country displayed no statistically significant trend in mobility for this place category. the remaining states spread across different parts of the country-mostly in the southern part displayed a statistically significant upward trend of mobility for this place categories. for this place category, the trend of mobility revealed that there are three contiguous regions across the country (fig. d) . kaduna, plateau, and fct formed a region of uptrend across the central part of the country, while the states from kwara to lagos down to delta and abia formed another contiguous region with a statistically significant uptrend in mobility. a contiguous region of no statistically significant trend surrounds kaduna, fct, and plateau uptrend region. this region of no discernible trend extends down to ebonyi, cross river, akwa-ibom, rivers, and bayelsa state. only a handful of states (borno, jigawa, kano, katsina, and sokoto) showed no statistically significant trend in mobility for workplaces. most states showed an upward trend in mobility during the period under consideration. for the residential place category, two states-(benue and kogi) showed an upward trend in mobility. this could be attributed to a late onset of infection recorded in these states. most of the states across the northeastern and north-western regions of the country showed no discernible trend of mobility. however, from kano down to abuja and nasarawa, niger to lagos, ondo through imo to cross river, there is an upward trend of mobility. ebonyi, rivers, and bayelsa are outliers with no definite mobility trend while being surrounded by states with a clear trend. a look at the new cases of covid- diagnosed during this same period (fig. ) revealed that there is a statistically significant uptrend across many states of the federation. osun, cross river, and taraba states represent a group of outliers, as they have no statistically significant trend and are surrounded by other states with an upward trend in the number of (weekly) new cases. sokoto, zamfara, kano, jigawa, and yobe state also have no discernible trend, however, they have neighbours with an upward trend in the number of new cases (fig. ) . the multiple correspondence analysis identified two dimensions within the mobility trend designation recorded for each state for the six place categories ( table ). the first dimension (d ), showed as high internal consistency (cronbach's alpha = . ) with an explained variance of %. the second dimension (d ) has explained a lesser proportion of the variance across the variables and has a lower level of internal consistency. the summary from table shows how correlated each of the quantified variables is related to the dimensions. most ( ) of the variables loaded highly (measures c . ) into d while none have similar attributes for d . this explained why d has a lower percentage of explained variance and lower internal consistency. from the result (table ) , there is an indication that d is the most relevant dimension for subsequent discussion. hence, the distribution of the object scores for d for each state was represented in fig. . from fig. , there are some contiguous regions with similar characteristics across the northern and southern regions of the country. while there is an element of a divide across the two regions, the difference is pronounced along the south-west and two-step cluster analysis (ibm ) was carried out to examine the natural groupings that may exist within d object scores. the internal consistency of the members within the groups identified was examined using the silhouette measure of cohesion and separation (rousseeuw ) . for this measure, cluster set with silhouette measure value [ . is considered to have a good cluster quality while \ . but [ . is considered fair. the summary of the auto-clustering operation presented in table , indicated that two clusters are the optimal number of clusters from the d object scores. the identification of two clusters is because the highest ratio of distance measure (table ) at . when the number of clusters is compared to . for clusters and . for clusters. based on this result, the cluster distribution showed that states ( . %) belong to cluster while the remaining belong to cluster (fig. ) . this clustering exhibited a good cluster quality (internal consistency) with a silhouette measure of . . the object score utilised is a multidimensional index quantify the trend of mobility across six place categories during the national lockdown period. as such the groups identified could give a reflection of the perception of risk of infection among people of each group of states. examining the cluster membership against the trend categories depicted in fig. a-f , the association can be identified (table ) . cluster members are mostly showing uptrend for grph park, and trst while most of them recorded a downtrend for resd. the mobility trend for rtrc and wkpl could not distinguish between the two clusters. however, for resd, cluster is quite distinct with most members having a downtrend in mobility, while most members of cluster show no discernible trend. most members of cluster also showed no discernible trend for grph, park, and trst. there is a wide variation in changes from baseline mobility for this period across the country. residential witnessed an overwhelming increase towards it while all the other place categories witnessed a decline relative to baseline. moreover, there is no clear-cut regional pattern discernible from the median mobility values for all the place categories. furthermore, while cumulative mobility for the unsafe place categories identified some hotspots of decline, a north-south divide is evident from the pattern. however, highly populated states such as kaduna and kano in the northern part of the country bucked that trend. as the lockdown draws longer, mobility toward retails and recreation facilities is ticking upwards. this is an indication that people need to get necessities and earn a living, movement cannot be effective if there are no alternatives to earn and secure daily needs. for parks, there seems to be a north-south divide in the mobility the ratios of distance measures are based on the current number of clusters against the previous number of clusters fig. distribution of d object scores cluster across the states increased mobility. this is partly due to the need to meet daily necessities and the need to take care of other existing or new ailments. mobility towards transportation hubs indicated that across states where infections were discovered earlier and states around them, people are beginning to accept the risk and travel more. in essence, people are making decisions (to travel) despite the constraints (zsolnai )-the risk of exposure, potentially lack of full understanding of the disease, and their chances of survival. the mobility trend for the workplaces indicated that fatigue is taking hold, and more people are moving towards their workplaces. this could be as a result of the overwhelming population of people who need to earn daily to survive despite the risk. thus, as more people gravitate toward their workplace the mobility trend recorded for residential areas is not surprising. across most states, people are venturing out more as the fatigue of staying at home gets overwhelming, and the need to earn a living is becoming more dominant on their mind. for reported new cases, the upward trend during the lockdown could be partly attributed to the varying level of enforcement of the mobility restriction, coupled with the need for many people to seek their daily income. this may have increased people's exposure and consequently infections. the 'infodemic' of misinformation-many conspiracies and fake news about the virus circulating on social media and the internet (zarocostas ) may also be partly responsible for this trend as there is a lot of scepticism across many parts of the country. write-ups and messages about instant remedies for the virus and several race targeted news were being propagated on various platforms (rathore and farooq ) . this surely will impact how seriously people considered the need to respect the mobility restriction orders. from the trend, there is an indication that mobility decision is being guided across most states by the risk acceptance principle. mobility is picking up with people likely considering covid- as just one of those ailments they are likely to get, as such they are willing to take the risk. with many states also having a few cases, there is also the tendency for people to underestimate the risk. most significantly, the need to earn a living is a more dominant driver of mobility as evident in the uptick in mobility towards transportation hubs, workplaces, and downward mobility trends for residential areas. recent studies showed that in the united states of america, covid- infection rates increased with city size (stier et al. ) . thus, the spread is effectively aided by mobility and proximity to urban landscapes as the quantum of cases is considerably higher for highly urbanised and densely populated states. therefore, the increase in mobility across most states, is an indication of either poor perception of the risk posed by increased mobility and/ or adoption of risk avoidance (non-pharmaceuticals) measures. while some can afford to stay at home, many cannot as they must earn their living every single day evidently, the mobility restriction is a luxury for some trend_grph trend_park trend_resd trend_rtrc and a severe cost for others. it is thus evident that the mitigation measures taken by each country will determine the course of the pandemic (anderson et al. ) . for example, there is evidence showing that as travel restrictions were implemented, this effectively slowed down the spread in the early days of the outbreak (chinazzi et al. ; kraemer et al. ) . while this may be the case, prolonged lockdown without adequate provision to manage the individual challenges such posed to many households (especially in nigeria where many required daily income to survive) will likely witness the waning of compliance as observed. this category of households as well as the rural dwellers were least compliant to the measures (carlitz and makhura ) . it is well established that vulnerability and extent of the impact of disaster or hazard are a function of location as well as the socio-economic circumstances of the people affected (lawal and arokoyu ) . from the mobility trend during the pandemic, some indications of risk perception could be deduced. for example, the level of risk acceptance is almost similar across most states especially considering their mobility towards retail, recreation, and workplaces. however, from the mobility around residential area cluster states are venturing out (more acceptance) while cluster states are neither here nor there about venturing out-an indication of uncertainty about the risk. this uncertainty was also indicated in their mobility towards parks, grocery, and pharmacy as well as transport hubs. the result indicated how knowledge, experience, values, attitudes, and feelings influence the judgement and decision about the acceptability and seriousness of risk-risk perception (slovic ) . there are differences between voluntary (knowingly taken risk) and involuntary (risk we are unable to control or not aware of) risk perception and the public willingness to accept voluntary risk is several folds greater than that of involuntary risks (smith ) . the way people view risk or perceived it is a major problem for mitigation. this was evident from the way varied mobility across the different cluster of states. therefore, actions taken by people (prevention and avoidance) is a function of their perception of the hazard (coppola ) . this perception also skews how they view the consequences and the likelihood of them getting infected. in essence, the actions captured by mobility gave a general indication of some aspects of peoples' perception of the risk, consequences and likelihood them getting infected. while it might be too early to conclude on the effect of the mobility restriction on the covid- spread and cases, it is noteworthy that the extent of compliance varies from state to state as evidenced by the findings from this study. thus, we might expect the evolution of the spread of the disease to follow the pattern of compliance with non-pharmaceutical measures e.g. mobility restrictions, use of face mask, hand washing, restriction of large number gatherings, etc. from the space-time analyses, we can conclude that mobility evolved along the line of necessities for each of the place categories i.e. high decline for most and concurrent increased for residential at the beginning of the lockdown followed by gradual increase for all others except residential towards the end of the lockdown. as mobility started an uptrend even during the lockdown period, there is an indication that generally, peoples' perception of the disease is to consider the pandemic as a voluntary risk. thus, the need to earn a living is much more overwhelming than to stay at home and be safe. higher resolution and multidimensional data would be required to ascertain how this plays out among different groups of people. but it could be expected that the perception may differ from person to person. there was an increase in number of cases during the lockdown, it is possible to conclude that this is as a result of the non-compliance with the lockdown protocols and potentially in the increase in testingleading to quicker identification of infected persons. the changes in compliance over time as indicated by mobility changes gave an indication of changes in risk perception and acceptance aggregated at the state level. thus, the conclusion is that mobility, could indicate how people perceive the risk they are exposed to and the level of risk they are willing to take. however, further research on risk perception and risk compensation during the pandemic is pertinent to examine this in more detail. the study utilised smartphone-based location data, thus, the mobility of people without gps enabled smartphone is not captured and people with phones without google location history enabled are not captured. thus, the data is incomplete but in the absence of mobility data for this period, there are no other alternatives. however, the data can indicate mobility during this period which is critical in tracking the distribution pattern as well as in predicting the number of cases in the various states. from the foregoing, it is pertinent that risk perception and risk acceptance should be tracked and understanding from such be incorporated in the management of the pandemic. as restriction and information fatigue sets in, there is need to device means to change behaviour and stimulate actions and attitude that will ensure people stay safe and prevent the spread and resurgence of covid- across various communities. funding the authors did not receive any funding from any organisation/institution for this study (study was not funded by any grant). conflict of interest the authors declare that they have no conflict of interest. human or animal rights this article does not contain any studies involving human or animals performed by any of the authors. proceedings of a special virtual conference on covid- of the association of nigerian geographers determining the vulnerability of states in nigeria to covid- . proceedings of a special virtual conference on covid- of the association of nigerian geographers geospatial enabling strategies for timely containment of covid- pandemic in lagos state perception, impact and coping strategies to covid- pandemic in nigeria how will country-based mitigation measures influence the course of the covid- epidemic? the lancet nigeria: coronavirus (covid- ) 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the covid- pandemic large-scale spatial-transmission models of infectious disease silhouettes: a graphical aid to the interpretation and validation of cluster analysis perception of risk abingdon: routledge covid- attack rate increases with city size. mansueto institute for urban innovation research paper distant decay analysis of airports and the number of confirmed covid- in nigeria insight into novel coronavirus-an updated intrim review and lessons from sars-cov and mers-cov how to fight an infodemic rational choice and the diversity of choices publisher's note springer nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations key: cord- - j w authors: ilesanmi, olayinka; afolabi, aanuoluwapo title: perception and practices during the covid- pandemic in an urban community in nigeria: a cross-sectional study date: - - journal: peerj doi: . /peerj. sha: doc_id: cord_uid: j w background: various perceptions and practices have been associated with the covid- pandemic. in this study, we assessed the perception and practices regarding covid- among residents in selected urban communities of ibadan, oyo state, nigeria. methods: a descriptive cross-sectional study design using a multi-stage sampling technique was used to recruit respondents (mean age: . ± . years; . % females) from households in ibadan. data were collected using an interviewer-administered questionnaire from rd to th june . those who demonstrated washing of the palm, back of the hand, spaces between the fingers, fingernails, wrist, and thumbs had six points and were categorized to have had a good practice of handwashing. descriptive statistics were conducted. bivariate analyses of sociodemographic characteristics and good handwashing practices were conducted using chi-square test. logistic regression was conducted to identify the determinants of good handwashing practices. p-values < . were statistically significant. results: going to the hospital ( %) and calling the covid- help number ( . %) were the frequently reported practices among respondents following the development of covid- symptoms. also, ( %) knew they could contract covid- , while ( %) perceived it as an exaggerated event. the effects most frequently reported by respondents were hunger/low income ( . %) and academic delay ( . %). use of face masks by . % and social distancing ( %) were the most frequently reported practices for prevention. only ( . %) demonstrated good handwashing practices. the perception of the likelihood to contract covid- and practices to prevent covid- had a weak correlation of . (p < . ). conclusion: gaps exist in the practices that prevent covid- . there is a need to improve handwashing, use of face masks and other practices that prevent covid- . implications across public health communication and policies were stated. the coronavirus infection is an emerging infectious illness which broke out during the winter of (al-hanawi et al., ; who, a) . due to its presentations, it has been declared a public health emergency of international concern by the world health organization (who) (who, a ). an alarming response has been introduced across the globe due to its high infectiousness and case fatality rate (zhong et al., ) . the identification of the risks and the prevention of infectivity regarding have been stated to depend on human perception (zhong et al., ) . especially in the submergence of an infectious disease such as covid- , different thoughts have shaped individuals' views on the illness. currently, the coronavirus disease has spread to countries with nearly million confirmed cases and close to , recorded deaths (who, b (who, , c . publicly available reports from the africa centre for disease control (acdc) states that confirmed cases of covid- had risen to , , and , deaths as of august (acdc, ). as of th august , the west african subregion accounted for a significant proportion of cumulative covid- records in africa. in nigeria, there are , confirmed cases of covid- with a total of , deaths as of august (ncdc, a; who, b) . oyo state presently holds the third spot on the nigeria centre for disease control (ncdc) daily covid- updates, with laboratory-confirmed cases of covid- and deaths (ncdc, b) . urban areas in ibadan, the capital city of oyo state frequently present with confirmed cases (enwongo, ) . as a part of the emergency response activities across all states in nigeria, health education campaigns have been directed at members of the public (ncdc, a (ncdc, , b . these campaigns have been aimed at knowledge improvement and the correction of certain misconceptions that have been widely circulated among community members (ncdc, a) . education on precautionary measures such as wearing of face masks, regular handwashing with soap and water or with alcohol-based hand sanitizers, and social distancing have been done (ncdc, a (ncdc, , b gbadamosi, ) . it is evident that perception shapes one's knowledge and the adoption of safety measures concerning the transmission of an infection. data obtained from the perception of community members regarding covid- could help target interventions needed to improve the knowledge of community members regarding coronavirus. superstitious beliefs have largely shaped the perception of most nigerians regarding the source and cause of covid- (chukwuorji & iorfa, ) . at the onset of the covid- outbreak in nigeria, infected persons belonged to either the political class or high socioeconomic cadre (chukwuorji & iorfa, ) . the characteristic prevalence of covid- infection among this group of persons accorded covid- the name, 'a disease of the rich and mighty' (nwaubani, ) . few months into the covid- outbreak in nigeria, perceptions revolved around "immunity" to covid- among the religious folks with a disregard of bans on religious gatherings (lichtenstein, ajayi & egbunike, ) . such perceptions could have been influenced by several factors. social media platforms such as whatsapp, facebook and twitter have been used to spread false news on covid- , resulting to panic disorder and anxiety among some persons and shunning of safety measures among others (aluh & onu, ; olapegba et al., ) . among many persons, physical distancing, social isolations, restriction of religious and social gatherings etc. have been opined as alien solutions in overcoming the covid- pandemic in nigeria and africa at large . literatures have reported the existence of knowledge relating to covid- among nigerians, and it is expected that this would influence precautionary behavior among them. however, inherent wrong perceptions may contribute to covid- risk aversion measures . perceptions of covid- has been influenced by age and gender. due to their increased vulnerability to illnesses, older persons have been predicted to increasingly adopt covid- precautionary behavior compared to other population groups . females have been identified as models in the adoption of precautionary health behavior. in the covid- context, the practice of handwashing, hygiene, and use of face masks occur more frequently among females than males . such an occurrence could be due to the perceived susceptibility to illnesses among females as well as their health-conscious nature. given the importance of risk perception in behavior modification for disease control, it becomes pertinent to assess the perception and practices regarding covid- . to the best of our knowledge, the perception and practices of community members in urban areas in ibadan regarding covid- is currently unknown. an assessment of the perception and practices of community members is important to reduce the risk for covid- infection in ibadan, a densely populated city in nigeria. we hypothesized that there is no difference in the sociodemographic characteristics of the community members with the practices of covid- mitigating factors. this study thus aimed at assessing the perception and practices of community members in urban areas in ibadan regarding covid- . a descriptive cross-sectional study design was used. data was collected using an interviewer-administered questionnaire. data collection took place from the rd to th june, . the study was carried out in ibadan, oyo state nigeria. ibadan is the capital city of oyo state. oyo state is one of the states in the south western part of nigeria. between june and august, , confirmed covid- cases had risen from to , in oyo state, and the state ranks next to lagos state and the federal capital territory on the ncdc reports for covid- (ncdc, b; enwongo, ) . the official language in nigeria is english, while the major informal language for communication in ibadan is yoruba, which has different dialects. the study population for the survey was one eligible member of the households in the selected urban communities in ibadan, oyo state. all consenting household members were included in the study. household members that were less than years were excluded. verbal consent was obtained from participants. the sample size was calculated using sample size formula for descriptive cross-sectional study. the population of the selected lga is > , . the sample size was calculated using the leslie kish formula for sample size determination for a single proportion as follows: n = za p( − p)/d where: n = minimum desired sample size z = the standard normal deviate, usually set as . which corresponds to % level of significance. p = % was be used d = degree of accuracy (precision) set at % ( . ) n = . × . × ( − . )/ . = a sample of ( . %) were studied in the urban communities of ibadan. a multi-stage sampling technique was used to select the respondents for the study stage : simple random sampling was used to select out of the urban local government area in ibadan. stage : in each of the selected lga, a political ward was chosen for the study. stage : a center location was chosen in the selected ward. a bottle was rotated to determine the direction of movement of the interviewers. from the direction of the bottle tip all consenting eligible adults from the households were included in the study until persons were interviewed in each lga. sampling of each in the three urban lga gives a total sample size of . the questionnaire has two sections. section a: sociodemographic characteristics the sociodemographic characteristics include age of respondents, sex, highest level of education, ethnicity and occupation. section b: perception and practices regarding covid- . close-ended questions were asked on perception of the respondents on covid- , their current practices, and what they would do if they were infected. open-ended questions were asked on the effects of covid- on and suggestions to the government to curb the pandemic. a six-point question was asked on the practice of handwashing. the respondents were asked to demonstrate how they usually practice handwashing. the interviewer correctly marked all the points demonstrated by respondents. the questionnaire was adapted from a tool used for a similar perception study on ebola virus disease in (gidado et al., ) . the tool was validated by an infectious disease epidemiologist. pre-testing of the tool was done by administering questionnaires in another local government area not selected for the study. a few ambiguous questions were modified. back-to-back translation of the questionnaire was done by experts who had sound understanding of the yoruba language. the questionnaire was administered to most of the respondents in yoruba language. data collection was done by trained research assistants with a minimum of first degree. independent variables included: sociodemographic characteristics like age, sex, level of education, and occupation. outcome/dependent variables were the practice of handwashing and the use of other mitigating measures. data were analyzed with spss version . age was summarized using mean and standard deviation, while frequencies and percentages were used for categorical variables. a total score of was assigned to good practice of handwashing after the respondents were asked to demonstrate hand washing. one point each was assigned for the following: palm, back of the hand, spaces between the fingers, fingernails, wrist and thumbs. only those who demonstrated the six points were categorized to have had a good practice of handwashing. chi-square test was used for the assessment of associations between sociodemographic characteristics and practice of handwashing. pearson correlation was conducted between the perception of the likelihood of contracting covid- and practices to prevent covid- . multivariate analysis of the determinants of good handwashing practices was conducted using logistic regression. p-values < . were accepted as significant. ethical approval to carry out the study was obtained from the oyo state ministry of health ethical review committee, with reference number ad/ / / a . permission for the study was sought from the respondents and the confidentiality of information was ensured. the respondents were informed of their right to decline or withdraw from the study at any time without any adverse consequences. no harm was inflicted on participants because of participation in this study. a total of respondents were interviewed among urban residents in ibadan. the mean age was . ± . years and ( . %) were females. those with secondary education and above were ( . %), ( . %) were of the yoruba ethnic group, and ( . %) engaged in business or trading (table ) . among the respondents ( %) have heard of covid- . most frequently reported practices among respondents following the development of covid- symptoms were: going to the hospital ( %) and calling the covid- help number ( . %). the other reported practices included: praying and staying at home each with ( . %) respondents as shown in fig. . regarding covid- risk perception, ( %) knew they could contract covid- , while ( %) perceived it as an exaggerated event. it was also perceived as an intention for corruption by ( . %), covid- was an attack by the western world was reported by ( . %) and ( . %) called covid- a source of panic. the effects most frequently reported by respondents were hunger/low income among ( . %) and academic delay among ( . %). regarding suggestions to the government, ( . %) suggested the provision of medical supplies/palliatives/seeking of cure, while ( . %) suggested free testing/free treatment. other effects of covid- and suggestions to the government are as shown in table . the most frequently reported practice for prevention of covid- among respondents were the use of face masks by ( . %) and social distancing by ( %). others included: staying at home/following covid- updates ( . %), taking vitamin c/fruits/ warm water ( . %), and doing nothing ( . %) as shown in fig. . figure shows that only ( %) of respondents demonstrated good handwashing practices. among respondents aged less than years, ( . %) had good handwashing practices compared to ( . %) aged above years. among females, ( . %) had good handwashing practices compared to ( . %) males although these differences are not statistically significant (table ) . males have . % less odds of having good hand washing practice compared to females, though not statistically significant (aor . , % ci [ . - . ], p = . ) ( table ). the perception of the likelihood to contract covid- and practices to prevent covid- had a weak positive correlation of . (p < . ). this study found that many individuals lived in denial of the existence of covid- . the perception of the illness as an avenue for politicians to enrich themselves indicates that there still exists inadequate knowledge of covid- among community members in ibadan. denial, ignorance regarding covid- , and the existing lack of trust in the nigerian government have been reported since the outbreak of covid- in nigeria (chukwuorji & iorfa, ) . from the present study, a high rating of the perceived likelihood of contracting covid- was observed among % of respondents, while it was minimally perceived as an attack by the western world among nearly %. findings obtained from this study revealed that the practices most often adopted following the development of covid- symptoms were either to go to the hospital or call the covid- help number. this indicates that the source of help for covid- symptoms (chukwuorji & iorfa, ). an indian study similarly reported that hospital visitation was frequently opted for as a step to be taken following the development of covid- in individuals in a close relationship (dkhar et al., ) . we found that the use of face masks and practice of social distancing measures were more frequently embraced among respondents compared to other covid- mitigation measures, although full adherence was low. a web-based study conducted in nigeria mostly stated mouth-covering while sneezing, wearing of face masks and avoidance of crowded spaces as self-reported practices among respondents . our findings revealed that myriads of perceptions were associated with covid- . these included covid- as an exaggerated illness with intentions for corruption, its highly infectious and deadly nature, and a reason for panic disorders. similarly, the likelihood of positive practices concerning covid- was associated with a positive perception of the risk of infection (zhong et al., ) . findings from previous studies conducted in nigeria also corroborate the key role of positive risk perception on imbibing covid- protective practices and attitudes . the finding from the present study however contradicts the assumption of the health belief model (hbm) that protective actions are more likely to succeed a high level of perceived susceptibility (tarkang & zotor, ) . the results obtained herein is higher than the knowledge concerning the practice of face masks in saudi arabia (al-hanawi et al., ) . due to its deadly nature, covid- has introduced fear which has compelled protective actions from individuals regarding the illness (zhong et al., ) . previous studies have shown that fear could motivate healthy behavior among individuals especially during epidemics, but such behavior may not be sustainable (witte, ; nabi, ; ufuwa et al., ) . the adoption of these healthy behaviors in the present study is in tandem with the recommendations of the world health organization (who) on safety measures for covid- (who, c) . the insufficiency of fear as a propellant for adherence to recommended guidelines for covid- has been reported to be an outplay of knowledge-attitude discrepancy . these findings imply that individual perception of infectious illnesses such as covid- may not be sufficient to influence the adoption of protective practices. this explains the need for the regular sensitization of community members on covid- safety measures regardless of their perception concerning the illness. we found that the practice of handwashing was commoner among individuals with a greater risk perception for covid- . because these individuals perceive themselves as vulnerable to covid- infection, they are more likely to engage in handwashing practice. handwashing practice has been identified as one of the mitigation strategies for breaking the chain of covid- transmission. an online-based nigerian survey revealed a higher practice of handwashing compared to other covid- preventive measures . a study conducted in ibadan on hand hygiene practices post the ebola virus disease outbreak revealed a high proportion of inadequate self-reported hand hygiene practice (martins & osiyemi, ) . lassa fever studies conducted in edo state reported inadequate handwashing practices, while a similar study in kaduna state, nigeria reported good handwashing practices among respondents (tobin et al., ) . the similarities of most of these findings with ours imply the wide acceptance of the practice of handwashing in the management of infectious diseases. findings from this study revealed a higher likelihood of good handwashing practices among females than males, although it was not significant. our finding contradicts cultural notions which suggests that hygiene measures are more frequently practiced among females than males. however, a few other studies have reported no difference in the practice of hand hygiene among males and females in nigeria (ogunsola et al., ; martins & osiyemi, ) . the agreement of our findings with reference literatures could be due to the alienation of regular and proper handwashing practices in the nigerian context. this could therefore have contributed to the observed level of handwashing practices among males and females as found in this study. the availability of water and sanitation access have been identified as major determinants of good handwashing practices (ogunsola et al., ) . however, these basic amenities are not readily available in many nigerian homes (uchejeso & obiora, ) . this therefore prompts overcrowding of persons at wells and boreholes, a condition which necessitates the use of water in we found that covid- poses significant threat to local economy, resulting in low income and resultant hunger. this is likely due to the increased cost of purchasing goods or a result of the lockdown which has denied many individuals the opportunity to earn their income. denial of opportunities to engage in money-making ventures was experienced and impacts such as hunger was greatly felt among many persons (chukwuorji & iorfa, ) . this explains the need for the provision of palliatives to fight hunger and reduce susceptibility to other infections during the covid- outbreak. similarly, decreased productivity and job losses and an unprecedented economic disaster have been reported (atalan, ) . contrary to the finding in this study, other studies have reported stress and anxiety as psychological reactions due to the coronavirus pandemic (atalan, ) . other psychological reactions such as boredom, anger, and loneliness have been notably identified as resultant threats during the covid- pandemic (aluh & onu, ) . this calls for the provision of psychosocial support for individuals during the covid- lockdown. interestingly, a recognition of the significance of essential staff has also resulted from the covid- outbreak (spowart, ) . pertaining to suggestions to the government concerning covid- containment, the provision of medical supplies and palliatives received highest recommendation among respondents. most nigerian households depend on daily earnings of breadwinners, and difficulty in survival was experienced during the covid- lockdown which lasted for three months in nigeria (chukwuorji & iorfa, ) . also, health education, the enforcement of preventive measures, and free testing and treatment received much recognition. these imply two things. firstly, health education campaigns concerning covid- should be conducted by public health officials in simple, unambiguous languages which will facilitate the understanding of community members. secondly, the availability of medical supplies and palliatives would enhance the adherence to safety measures for covid- , such as the use of face masks among community members. similar suggestions have been made in previous studies (kebede et al., ) . up to date, most studies on perception and practices regarding covid- have used electronic sources for data collection, and such results may have been biased. our study is a community-based physical study that used a semi-structured interviewer-administered questionnaire. to the best of our knowledge, it is the first to study the perception and practices of adult population in urban communities in nigeria. the study also made use of an adequate sample size ( adults). as this study was limited to the perception and practices regarding covid- , the knowledge of community members on the illness was not addressed. the assessment of factors influencing covid- practices among community members was obscure in this study. the adoption of preventive measures is critical to forestall onward transmission of covid- . however, adequate, and correct risk perception for covid- is required to enable the adoption of covid- safety measures. we hereby recommend enhanced sensitization and health education sessions for all community members about covid- in ibadan metropolis regardless of their sociodemographic characteristics. also, health campaigns should be more focused on practices such as regular handwashing with soap and water and social distancing, which protect against transmission of covid- among community members irrespective of their sex. in addition, access of individuals to portable source of water supply should be enabled by increased provision of water sources in residential apartments. the government should also install more infrastructures for water supply where dearth of water exists. coronavirus disease (covid- ): africa centre for disease control knowledge, attitude and practice toward covid- among the public in the kingdom of saudi arabia: a cross-sectional study the need for psychosocial support amid covid- crises in nigeria. epub ahead of print is the lockdown important to prevent the covid- pandemic? effects on psychology, environment, and economy-perspective knowledge, attitude, and practices related to covid- pandemic among social media users in j&k covid- : oyo confirms new cases in lgas war on covid- : oyo threatens to shut markets for flouting precautionary measures-oyo state. the pace setter state public knowledge, perception and source of information on ebola virus disease covid- knowledge, risk perception and precautionary behavior among nigerians: a moderated mediation approach knowledge, perceptions and preventive practices towards covid- early in the outbreak among jimma university medical center visitors, southwest ethiopia across africa, covid- heightens tension between faith and science: some leaders reject expert advice to ban religious gatherings hand hygiene practices post ebola virus disease outbreak in a nigerian teaching hospital a cognitive-functional model for the effects of discrete negative emotions on information processing, attitude change, and recall covid- nigeria-nigeria centre for disease control covid- outbreak in nigeria situation report-abuja: nigeria centre for disease control coronavirus: why some nigerians are gloating about covid- -bbc news perception and practice of handwashing in kuramo community covid- knowledge and perceptions in nigeria covid- : how lockdown could affect our relationships. the national application of the health belief model (hbm) in hiv prevention: a literature review knowledge and practice of infection control among primary care providers in an endemic suburban community of edo state: implications for control handwashing and personal hygiene among nigerians in the face of covid- (coronavirus) knowledge and risk perception towards lassa fever infection among residents of affected communities in ebonyi state, nigeria: implications for risk communication covid- ) situation report- geneva: world health organization coronavirus disease (covid- ) situation report- geneva: world health organization coronavirus disease (covid- ) advice for the public: world health organization fear as motivator, fear as inhibitor: using the extended parallel process model to explain fear appeal successes and failures knowledge, attitudes and practices towards covid among chinese residents during the rapid rise period of the covid- outbreak: a quick online cross-sectional survey the authors express their gratitude to all community members for their willingness and cooperation to participate in this study. the authors received no funding for this work. the authors declare no competing interests. olayinka ilesanmi conceived and designed the experiments, performed the experiments, analyzed the data, prepared figures and/or tables, authored or reviewed drafts of the paper, and approved the final draft. aanuoluwapo afolabi performed the experiments, analyzed the data, prepared figures and/or tables, authored or reviewed drafts of the paper, and approved the final draft. the following information was supplied relating to ethical approvals (i.e., approving body and any reference numbers):ethical approval to carry out the study was obtained from the oyo state ministry of health ethical review committee, with reference number ad/ / / a. the following information was supplied regarding data availability:raw data is available as a supplemental file. supplemental information for this article can be found online at http://dx.doi.org/ . / peerj. #supplemental-information. key: cord- - bhgq q authors: bolarinwa, o. a.; olagunju, o. s.; babalola, t. title: adherence to covid- pandemic prescribed recommendations, source of information and lockdown psychological impact of nigeria social media users date: - - journal: nan doi: . / . . . sha: doc_id: cord_uid: bhgq q background: covid- is a highly infectious viral disease that has spread to over one hundred and eight countries, including nigeria. countries across the globe have been implementing preventive measures towards curbing the spread and impact of the virus. thus, the present study was aimed at assessing compliance to prescribe preventive recommendations, the psychological effect of lockdown, and the source of information among nigeria social media users. methods: this research implemented an online cross-sectional survey using an unidentified online google based questionnaire to elicit required information from potential respondents via social media channels such as whatsapp, twitter, instagram, telegram and facebook. on these forums, an external link with google based questionnaire was shared with nigerians social media users to participate from st to st april and we had , respondents who participated in the survey. results: age and respondent's scientific or non-scientific backgrounds were the socio-demographic variables associated with respondents having psychological challenges as p< . . however, none of the socio-demographic variables of the respondents were associated with compliance with the recommendations as p> . . also, most ( . %) of the respondents were stressed by the feelings associated with the covid- pandemic, as the expected majority ( . %) sources information about the epidemics through social media platforms. conclusion: given numerous uncertainties surrounding the global covid- pandemics, there is a need to continuously increase awareness through various media and ensure that people are highly complying with the preventive measures being put in place by relevant authorities. also, palliative measures should be put in place to reduce the psychological impact of the pandemic. the / coronavirus, also known as covid- , is an ongoing pandemic. the virus, a viral infectious disease caused by severe acute respiratory syndrome as now spread across the world, and almost all the countries are battling with the virus , . governments and medical officials are also trying their best to curb the spread as much as possible . the virus is transmitted by aerosols that could remain suspended in the air for many minutes after coughing or sneezing or via close personal contact, such as by touching or shaking hands with an infected person. these viruses may also spread when people touch contaminated objects or surfaces and then their mouth, nose, or eyes. moreover, it can remain viable for a few days on multiple surfaces , . people with comorbidities and males older than years are assumed to be at the risk of the virus . however, all population is at the risk of covid- irrespective of their demographic composition. the epidemic has been declared by the world health organization (who) as a public health emergency of international concern on st january , and on th march of the same year, who declared the outbreak a pandemic , . as of nd may , over . million cases and , deaths have been reported in all the continents , and these cases are still growing. gilbert and colleagues' modelling study of the risk of covid- importation from china indicates that the ability of african countries to manage the local transmission of the virus after importation hinges on implementing stringent measures of detection, prevention, and control . the country with the secondhighest import risk ranking was nigeria, with moderate capacity but high vulnerability and potentially significantly larger populations that are exposed to inefficacy health systems . however, nigeria demonstrated its ability through intensifying its preparedness against covid- importation, drawing on recent successes in controlling polio and ebola epidemics . the first reported case of the novel virus was imported into nigeria in february by an italian citizen. the number which currently stood at reported cases and deaths . without a vaccine in hand, it seems that the virus can only be slowed by extreme behavioral change and societal coordination . preventative measures implemented by national, state, and local governments worldwide now affect the daily routines of millions of people worldwide, and the rule includes social distancing and non-. cc-by . international license it is made available under a is the author/funder, who has granted medrxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint the copyright holder for this this version posted september , . . https://doi.org/ . / . . . doi: medrxiv preprint movement between and within countries [ ] [ ] [ ] . these changes are essential to beat coronavirus and protect health systems . existing research has demonstrated that the current most effective and efficient public health interventions are only feasible when the public duly accept them . however, preliminary reports show vast differences in people's willingness to practice measures that can reduce pathogen transmission , . a study in italy concluded that most demographic groups believed and followed health measures ; also, a sentiment study conducted in india on lockdown showed that the embossed sentiment was positive. even though there were negativity, fear, disgust, and sadness about the lockdown . due to the high cost of complete isolation and healthcare, compliance with recommendations to strategically reduce contact is likely to be higher . the covid- pandemic is a global health emergency that could potentially have a severe impact on public health. lockdown measures included travel restrictions, the mandatory closure of schools, nonessential commercial activities, and industries. people were asked to stay at home and socially isolate themselves to prevent being infected . these measures are necessary to fight the novel coronavirus disease. although effective in preventing the uncontrolled spreading of covid- , these measures can negatively affect mental health , and relaxation will almost certainly trigger a further epidemic wave of deaths . social separation or quarantine of non-infected persons for an extended period may have adverse effects, such as loneliness, a rise in fear and anxiety and also, mental health consequences [ ] [ ] [ ] [ ] [ ] . studies in the past related to another family of coronavirus have also been linked to anxiety, depression, and psychological challenges as an aftermath effect of previous outbreaks . fear of the unknown raises anxiety levels in healthy individuals as well as those with pre-existing mental health conditions . there has been a global rise recently in the spread of misinformation that has plagued the scientific community and the public. the public health crisis emerging due to the coronavirus (covid- ) is also now beginning to feel the effects of misinformation . in our current digital world, online platforms are perhaps the most accessible source of health-related information for the public . as more and more social interactions move online, the conversation around covid- has continued to expand, with growing numbers turning to social media for both information . cc-by . international license it is made available under a is the author/funder, who has granted medrxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint the copyright holder for this this version posted september , . . https://doi.org/ . / . . . doi: medrxiv preprint and company . twitter and other social media platforms are essential sources of breaking news around the globe. it can also be a crucial vehicle in disseminating new public health information . the current novel coronavirus outbreak has spread around the world as such strategic dissemination of accurate and efficient public health messages by the government and centre for disease control (cdc) through the internet or television is strong potential to alleviate unnecessary fear , , . limited studies have been able to link how compliance with the prescribed recommendation, source of information, and lock psychological impact can either inflate or deflate the propagation of covid- . thus, this study examined the compliance level to covid- prescribed recommendations, the psychological implications of lockdown, and the source of information on covid- among nigeria social media users. the main objective of this study was to examine adherence to prescribed recommendations, lockdown psychological impact & source of information among nigeria social media users. this cross-sectional survey used a google-based, anonymous online questionnaire to gather data from respondents via social media platforms such as telegram, instagram, facebook, whatsapp, and twitter. on these platforms, the google based questionnaire was shared among nigeria social media users to participate. a snowball sampling technique was adopted to involve more nigerians who are social media users and are residing in nigeria during the covid- pandemic by telling those who were first sent the external google based questionnaire link to kindly share with their contacts. this unidentified online survey was conducted for one month within nigeria social media users from april to st may , and we had , who participated in the online survey. due to the social distancing rules imposed by the nigerian government and the enforcement of curfew/lockdown, physical interaction was not feasible, so the study survey was promoted online via social media, and existing study participants were encouraged to share the online google based . cc-by . international license it is made available under a is the author/funder, who has granted medrxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint the copyright holder for this this version posted september , . . https://doi.org/ . / . . . doi: medrxiv preprint questionnaire with potential respondents. participation was completely consensual, voluntary and anonymous. all respondents were given informed consent by asking if they were interested in participating the online google based questionnaire for this study, and those who showed that they are not interested in participating were signed-out from completing the next phase of the online google based questionnaire and those who agreed to continue the move to the next phase involving the completion of the online google based questionnaire. the online google based questionnaire elicited socio-demographic variables such as gender, age, educational attainment, professional history of the respondents, while dependent variables such as compliance to prescribed recommendations, the psychological impact of lockdown, and source of information during the lockdown among nigeria social media users. this section of the study summarizes the variables used in the study. respondent age, gender or sex of the respondents, educational level, and professional background variables were used as explanatory variables. the dependent variables were recommendation compliance, feeling regarding covid- pandemic, and respondents' adaptation. recommendation compliance refers to whether respondents comply with the country's ministry of health recommendations. feeling regarding the covid- pandemic refers to the respondent's feelings concerning stress. respondents were asked about their opinions regarding the covid- epidemic; those that reported nervous/anxious, fear, angry, lonely, and bored were coded stressed while those that said just fine, happy, and relaxed/optimistic were coded not stressed. respondent's adaptation refers to comping strategies used by respondents. respondents were coded adapting well if respondents engaged in positive activities like watching television, reading books/magazines, volunteering, work from home, etc. while respondent was coded not adapting well if they engaged in harmful activities like fighting with everyone, talking to themselves, having problem sleeping, etc. . cc-by . international license it is made available under a is the author/funder, who has granted medrxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint the copyright holder for this this version posted september , . using stata tools, the data collected from the nigeria social media were analysed. the findings were described in table and figure formats, using frequencies and percentages to explain specific variables of the sample population. further, chi-square analysis was conducted to predict the influence of sociodemographic factors with the outcome variables. results with a p-value < . were significant predictors in the bi-variate analysis. the study was approved by the ethics committee of obafemi awolowo university, nigeria. participants' permission was sought before filling out the online google based questionnaire. those who refused were not permitted to participate. all those who agreed to participate in the survey were granted access. table is a socio-demographic sample of respondents. the table revealed that more than percent of respondents were between the ages of to , while the remainder were between the ages of and above. sex reveals . % were male, and . % were female. the table shows that respondents who were well educated were %, this means out of every ( . %) had a bachelor's degree, . % had a master's degree, . % had a ph.d., . % had a high school certificate and only . % had no formal education. out of every respondent reported that they follow the country ministry of health recommendations. when asked about the extent they follow the recommendations, out of every ten reported that they follow all the recommendations. respondents were asked how frequently they touch their face, only . % reported that they never touch their face, . % rarely touch their face, . % touches their face sometimes, . % touches their face often, and only % touch their face always. is the author/funder, who has granted medrxiv a license to display the preprint in perpetuity. the copyright holder for this this version posted september , . . https://doi.org/ . / . . . doi: medrxiv preprint table presents the respondents' psychological effects and coping strategies & source of information. six out of every ten respondents reported that they were stressed, and about four reported that they were not stressed. concerning coping and adaptation during the lockdown, . % reported that they are adapting well by watching tv/movies, spending time with family, reading books/magazines, and working from home. source of information about the covid- pandemic revealed that out of every ten respondents heard the information from social media (facebook, instagram, whatsapp profile, etc.) while the remaining heard from tv ( . %), friends/family ( . ), newspaper ( . %) and other sources ( . %). is the author/funder, who has granted medrxiv a license to display the preprint in perpetuity. the copyright holder for this this version posted september , . . https://doi.org/ . / . . . doi: medrxiv preprint recommendation. concerning gender, level of education, and respondent background, the table shows that none of these were significantly related to recommendation compliance. stressed during the covid- pandemic, but this is not statistically significant in this study. gender and background of the respondent also show no statistically significant table : association between socio-demographic and feeling regarding covid- pandemic . cc-by . international license it is made available under a is the author/funder, who has granted medrxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint the copyright holder for this this version posted september , . table presents the respondent's socio-demographic and adaptation during the pandemic. the table shows that about out of every ten respondents in - , - , - , and - age group categories well adapting compared to about out of every in the age group - , but this is not statistically significant in this study. gender and level of education were not statistically significant. still, the table revealed that about out of every ten respondents with high school, higher education, and postgraduate in the level of education categories reported that they were adapting well. the background of the respondent shows a statistically significant relationship in that more of the respondents with a scientific/medical background were adapting well. table : association between socio-demographic and respondents' adaptation . cc-by . international license it is made available under a is the author/funder, who has granted medrxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint the copyright holder for this this version posted september , . the study was carried out to examined how people in nigeria are complying with recommendations from the country's health authority, lockdown psychological impact, and source of information among social media users in nigeria. as the world faces the coronavirus threat (covid- ), many commentators and national leaders around the world are beginning to recognize this as a genuine threat . cc-by . international license it is made available under a is the author/funder, who has granted medrxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint the copyright holder for this this version posted september , . to national security. however, in terms of human behaviour, the danger does not come from an external adversary but from people who refused to comply with rules and orders and fail to adjust their actions to respond to the changing situation. the person who fails to comply with the coronavirus is an active and ongoing threat to others as well as or sometimes more than to themselves. compliance with guidance and prescribed protocol is a common and well-established medical issue. people do not routinely do what's right for them and refuse to stop behavior that's bad for them. this same behavior pattern was expected in respect of covid- restrictions in nigeria. finding from this study shows that almost all the respondents adhere to the recommendation and guidelines and compliance with the recommendation was not associated with respondent's socio-demographic explore in this study. it is crucial to know how people are adapting to their various environments in this strange period. findings show that respondents who are young and active were adjusting well. this may be because they have the energy to engage in different activities. also, young people are the best with technology, with the internet they can relate with their friends in any part of the world. concerning education, the study shows that more educated persons were adapting well. this is because they are more knowledgeable and can easily understand the situation compared to those with no formal education. the respondent background was not another variable explore on adaptation in this study. the finding shows that respondents with science/medical background are more likely to adapt well because of their awareness of preventive measures, treatment of diseases, and they can administer and recommend drugs. the study also assesses the psychological impact of lockdown on respondents concerning whether they are stressed or not. the finding shows about % reported that they are confirmed, which is more common among respondents within the age group of - , - , - , and - years. this may be because most of them are breadwinner/head of their family that needs to cater to many things for the household. also, this is the active/working-age group in which many of their activities have been affected by the lockdown. source of information is another crucial variable to look at during this period because it is critical to know the medium to use when there is a need to disseminate information in terms of reach out. finding from this study shows that the majority get updates about covid- from social media. . cc-by . international license it is made available under a is the author/funder, who has granted medrxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint the copyright holder for this this version posted september , . . https://doi.org/ . / . . . doi: medrxiv preprint the author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. ethical approval: participants' permission was sought before filling out the online google based questionnaire. those who refused were not permitted to participate. all those who agreed to participate in the survey were granted access. contributorship: oab was the principal investigator of the study, research the literature and drafted methodology. oo analysed the collected data and wrote the discussion. tb was involved with designing the questionnaire, writing of abstract and general editing and proofreading. . cc-by . international license it is made available under a is the author/funder, who has granted medrxiv a license to display the preprint in perpetuity. 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(which was not certified by peer review) preprintthe copyright holder for this this version posted september , . . cc-by . international license it is made available under a is the author/funder, who has granted medrxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprintthe copyright holder for this this version posted september , . . https://doi.org/ . / . . . doi: medrxiv preprint key: cord- -d p u authors: bello, ajide kazeem; ridwan, lanre ibrahim; alimi, yasiru olorunfemi title: estimating the impacts of lockdown on covid- cases in nigeria date: - - journal: nan doi: . /j.trip. . sha: doc_id: cord_uid: d p u the study examines the extent to which lockdown measures impact on covid- confirmed cases in nigeria. six indicators of lockdown entailing retail and recreation, grocery and pharmacy, parks, transit stations, workplaces, and residential, are considered. the empirical evidence is anchored on the negative binomial regression estimator, due to the count nature of the dataset on the daily cases of the virus. the study established the key following findings: first, retail and recreation, grocery and pharmacy, parks, transit stations, and workplaces are statistically significant and negatively signed as relevant predictors of the virus. second, the impact of residential is positive and statistically significant at the conventional level. lastly, the results are robust to an alternative estimator of poisson regression. the emanated policy message centres on the need to direct efforts toward ensuring total compliance to the lockdown rules as it holds the key to keeping the virus under check. against the foregoing backdrop, this study seeks to examine the impact of lockdown on covid- cases in nigeria. the present study, to the best of knowledge is the first empirical attempt at examining the effects of lockdown on covid- for the country, specifically from an econometric perspective. there is no denying the fact that there have been a series of policy papers, opinions, and predictions about the pandemic for the country. however, most of these submissions can be best described as purely qualitative empirical exercise, building merely on hunches, perceptions or at best, intuitive logics. thus, this study is quantitative based in nature, thus presenting the contribution to the stock of extant literature on covid- at least from the country-specific stance. while the introductory takes up the first section, the stylized facts about the lockdown measures vis-à-vis the virus spread in nigeria are presented in section two. section three presents a brief review of the extant literature; sections four and five dwell on the empirical strategy and estimation of the lockdown-covid- nexus. section six concludes with some policy implications and caveats. this segment presents the stylized facts about coronavirus cases in nigeria during the lockdown periods. for ease of comprehension, the lockdown period is partitioned into three phases: pre-lockdown, lockdown, and lockdown easing. this division will provide a deep understanding regarding covid- cases during these identified phases. j o u r n a l p r e -p r o o f in the pre-lockdown phase, no palpable pattern can be discerned from the trend regarding the number of confirmed cases. the lockdown phase witnesses some dramatic changes in covid- cases as compared to the pre-lock down period. however, in the latter part of the lockdown, there were several sporadic spikes with the highest reported cases being in a single day. the easing period equally experiences some increases, as can be observed from the diagram. on the first day of the easing, cases were recorded, while the subsequent days witness upward trends in the number of confirmed cases. figure presents the summarized version for the three periods in which the total aggregate of the easing surpasses , altogether. the same figure displays the state ranking with respect to the reported cases of covid- in which the lagos state surpasses other states, thus topping the list, and directly followed by fct, kano in that order. j o u r n a l p r e -p r o o f note: confirmed= total number of confirmed positive cases of covid- based on clinical tests from the index to the most recent reported cases. active= the number of covid patients on admission and undergoing treatment at the various isolation centers. recovered= the number of covid- patients who have tested negatives after treatment and are certified free of the virus by medical personnel. death=the number of people who lost their lives courtesy of the virus. the literature on covid- can, at best, be described as emerging or in its embryonic stage. thus far, the available studies on covid- have only examined the prevalence and control measures (ceylan, , zhao et al., , governance, technology, and citizen behavior (shaw et al., ) , socio-economic impacts (tang et al., ) . other strands had equally focused on respiratory syndrome (al-raddadi et al., ) , temperature (briz-redón & serrano-aroca, ), mortality rates (ferdinand & nasser, ; wang et al., ) , and climate factor (tosepu et al., ) , among others. on the nigerian front, studies have concentrated on the resurgence of lassa fever amidst covid- outbreak (reuben et al., ) , almajiris displacement (akintunde ), comparative analysis of models and estimators (ayinde et al., ) , hunger prevalence (kalu, ) , online forecasting (abdulmajeed et al., ) , impact on transportation (mogaji ) , and economic crisis (ozili, ) . relatedly, studies on social distancing and the spread of covid- cases include de vos, ; friedman et al., ; schueller et al., ; musinguzi et al., ; vinceti et al., ; and zhang et al., . these studies only focused on countries from the developed and emerging nations, implying that little or nothing is on record concerning the african countries. this is in fact, surprising given the prevalent rate of the virus across the countries j o u r n a l p r e -p r o o f in the continent in general, and sub-saharan african economies like nigeria in particular. this study fills this lacuna. it is worth mentioning also that the large chunk of the extant studies has only adopted descriptive or at best, discussion methods (akintunde et al., ; al-raddadi et al., ; crossley, ; mogaji, ; ozili, ; shaw et al., ) , while those embracing econometric approaches are scanty to date (ayinde et al., ; ceylan, ) . this study employs a negative binomial regression to unravel the impact of lockdown on covid- cases in nigeria for at least two reasons; first, the dependent variable used is a count data that only covers discrete and nonnegative values. thus, as a skewed discrete distribution, using ordinary least squares (ols) estimates can only yield inefficient, inconsistent, and biased (long, ) . second, if this dependent variable fits equi-dispersion, then the poisson regression model becomes inevitable. if otherwise, using negative binomial model remains a credible option. this estimator is often used when the variance is larger than its mean (over-dispersion). the robust standard errors are further clustered in order to produce standard errors that are robust to both heteroskedasticity and a general-type of serial correlation within the cross-sectional unit. more importantly, this estimator has found extensive application in studies such as accidents, conflicts, terrorism among others, given the count data nature of their data (gassebner and luechinger ; krieger and meierrieks , ajide and raheem, ; ajide, adenuga and raheem, ). in a more general form, to specify a negative binomial regression, the mean of the outcome variable y is determined by the exposure time t and a set of k explanatory variables (the ' xs). hence, the empirical expression relating to these quantities is specified as: j o u r n a l p r e -p r o o f the regression coefficients are thus estimated using the method of maximum likelihood. (see, ncss, ). the study employs an all-inclusive daily situation report of covid the data on lockdown is obtained from google mobility data. the descriptive statistics are presented in table . from the table, at the level of the states, lagos has the highest recorded covid cases (see table ), which is consistent with figure above. table presents the results of the negative binomial regression estimations of the lockdown effects on covid- for nigeria. the results for all the indicators of lockdown variables are statistically significant and negative except for the residential variable. these results consistent with the theoretical priors, suggesting the mitigating role of lockdown policies on coronavirus spread. by implication, as people comply with the "stay-at-home" order, and limit their visits to essential places, thus reduce their chances of being infected by covid- . correspondingly, this also tends to reduce human-to-human contact, which is the main transmission channel of covid- . intuitively, a % increase in compliance to the stay-athome order leads to a corresponding reduction by the magnitudes . %, . %, . %, . % and . %. on the contrary, the impact of residential is positive and statistically relevant. this sounds plausible as people desert essential places of visits, they tend to increase their presence at home. in particular, the majority of infected persons usually have one or more of their family members or close relatives infected. this explains why residential remains a key predicting channel to contacting covid- and such reasons can be advanced as why covid increases during the lockdown. j o u r n a l p r e -p r o o f this study examines the extent to which lockdown measures impact on covid- confirmed cases in nigeria. using the negative binomial regression estimator on the daily situation data, the following results are established. first, retail and recreation, grocery and pharmacy, parks, transit stations, and workplaces are negative and statistically significant across the models. second, the impact of residential is positive and statistically relevant, thus running contrary to other lockdown measures with negative theoretical priors. lastly, the obtained results are robust to an alternative estimator of poisson regression. the study has some relevant policy implications. first, since the importance of lockdown policy has been quantitatively confirmed to be effective in combating the spread of covid- cases, focus should be placed on residential houses, which act as a spur to the virus. this can be effectively achieved through public enlightening programs and general awareness on the need to comply with lockdown measures. more importantly, the government should guarantee and ensure constant supply of electricity to the people, their staying at home is largely predicated on enjoying uninterrupted supply of electricity. this sounds plausible in the nigerian context where the supply of electricity has been erratic most times. this has often remained one of the reasons why people seek pleasure outside of their homes. this mostly takes the form of visits to relaxation centres like parks, recreation centres, restaurants, etc. second, if the government has to ease the lockdown, at all, it must be gradual with all the necessary precautions dully enforced. notwithstanding, this must be supported by sanctions to the defaulters. third, lack of necessary welfare-oriented supports from the government serves as a reason people often advanced for not making them ''compliant agent(s)'' during the lockdown periods. going forward, future research can be conducted using the state-level unit of observations for analysis in order to arrive at a more robust policy generalization. what is more, since nigeria shares similar socioeconomic and political characteristics with other african countries, the outcome of this research work could serve as useful research inputs for other countries in the region to extrapolate. all the authors participated in the making of the manuscript. specifically, ajide kazeem bello conceived and designed the manuscript. ridwan, lanre ibrahim provided empirical studies, data, and proofread the manuscript. alimi, olorunfemi yasiru, handled the model estimation of and proofread the manuscript. online forecasting of covid- cases in nigeria using limited data does democracy really fuel terrorism in africa? natural resource rents, political regimes, and terrorism in africa public health implication of displacement of almajiri children in specific states of northern nigeria amidst covid- pandemic burden of middle east respiratory syndrome coronavirus infection in saudi arabia modeling nigerian covid- cases: a comparative analysis of models and estimators a spatio-temporal analysis for exploring the effect of temperature on covid- early evolution in spain indirect virus transmission in cluster of covid- cases wuhan lockdown unprecedented, shows commitment to contain virus: who representative in china estimation of covid- prevalence in italy, spain, and france. science of the total environment covid- in nigeria: a disease of hunger. the lancet impact of covid- on transportation in lagos, nigeria. transportation research interdisciplinary perspectives nigeria centre for disease control (ncdc, ) covid- pandemic and economic crisis: the nigerian experience and structural causes is the covid- pandemic masking the deadlier lassa fever epidemic in nigeria? an updated estimation of the risk of transmission of the novel coronavirus ( -ncov). infectious disease modeling correlation between weather and covid- pandemic in jakarta real-time estimation and prediction of mortality caused by covid- with patient information based algorithm preliminary estimation of the basic reproduction number of novel coronavirus ( -ncov) in china, from to : a data-driven analysis in the early phase of the outbreak j o u r n a l p r e -p r o o f the authors have no conflict of interest and no fund was received in favor of this study. (- ) . *** . *** . *** . *** . *** . *** . *** . *** . *** . *** . *** . *** . *** . *** . *** ( . ) ( . ) ( . ) ( . ) ( . ) ( . ) ( . ) ( . ) ( . ) ( . ) ( . ) ( . ) ( . ) ( . ) ( . ) % ∆ of retail and recreation - . *** . . *** . *** . *** j o u r n a l p r e -p r o o f key: cord- -eeqv xa authors: umeizudike, kehinde adesola; isiekwe, ikenna gerald; fadeju, adeyemi dada; akinboboye, bolanle oyeyemi; aladenika, emmanuel temitope title: nigerian undergraduate dental students’ knowledge, perception, and attitude to covid‐ and infection control practices date: - - journal: j dent educ doi: . /jdd. sha: doc_id: cord_uid: eeqv xa purpose/objectives: the current coronavirus disease (covid‐ ) pandemic has affected most countries. infection, prevention, and control training is important in mitigating the spread of covid‐ . the closure of universities by the nigerian government has hampered academic activities of dental students. our objectives were to assess the knowledge, perception, and attitude of undergraduate dental students in nigeria to the covid‐ pandemic and infection control practices. methods: this was a cross‐sectional study of undergraduate clinical dental students from the dental schools in nigeria. self‐administered questionnaires were distributed to participants using an online data collection platform. correct responses to the ‐item questionnaire on covid‐ knowledge were scored to determine their knowledge level. a likert scale of ‐ was used to assess the ‐item perception and attitude questions. the level of significance was set at p values ≤ . . results: a total of undergraduate clinical dental students participated in the study. males represented . %, and mean age was . ± . years. fifty percent of the students had adequate knowledge of covid‐ . final‐year students ( . %) demonstrated more adequate knowledge of covid‐ than penultimate‐year students ( . %, p = . ). most ( . %) respondents had positive attitudes towards infection control practices against covid‐ . conclusion: although the clinical dental students had a positive attitude to infection control practices against covid‐ , the overall knowledge of covid‐ was barely adequate. guidelines on covid‐ from reputable health authorities should be reviewed by dental school authorities and disseminated to the students to suit their clinical practice. the new coronavirus infection was first identified in a cluster of patients admitted into hospitals for suspected pneumonia of an unknown cause, later linked to a seafood and wet animal market in wuhan city, hubei province, china, in december . this coronavirus has been identified as the severe acute respiratory syndrome coronavirus (sars-cov- ). this infection was named the novel coronavirus disease (covid- ) on february , by the who. as the disease began to spread rapidly across several countries, the covid- outbreak was declared a global pandemic by the who on march , . since the initial cases, covid- has affected more than million people globally with over , deaths in about countries and territories as of september , , thus posing a serious and alarming public health concern. since the index confirmed case in nigeria on february th , , the number of confirmed cases have risen to , with covid- related deaths, as of september , . the increase in the number of confirmed cases led the federal government of nigeria (fgn) in march to effect the immediate closure of all educational institutions including universities, airports, land borders, and religious and recreational centers, amongst others, as major efforts to curb the spread of the infection. the nigeria centre for disease control (ncdc) in partnership with the ministry of health and state governments has been actively involved in contact tracing, testing, isolation, and treatment of covid- cases in nigeria. numerous campaigns have been embarked upon through the media for preventive measures such as hand hygiene, respiratory etiquette, social/physical distancing, noncontact temperature screening, and facemask wearing in public places to limit the spread of the disease. the covid- pandemic has also affected dental training schools and dental clinics all over the world, with initial restrictions to emergency and urgent dental care. [ ] [ ] [ ] the nigerian dental association also issued some guidelines on covid- protocol for dental clinics in nigeria to postpone elective procedures in april, . this is due to the reported high risk of infection amongst dental professionals as a result of the large amounts of aerosols generating procedures and their close proximity to patients in confined treatment offices/clinic. the coronavirus has also been found in the saliva of infected persons, and shown to survive in aerosols for hours and on surfaces for days. the closure of universities by the fgn in a bid to limit the spread of covid- , has hampered the academic activities of dental schools and clinical training of dental students in nigeria. the pandemic also affected the training activities of dental students in countries such as china and canada. dental students in china had to continue learning online after the chinese spring festival and were told not to return to school until further notification at the onset of the pandemic. also in canada, many third-and fourth-year undergraduate dental students within a dental geriatric module in the university of british columbia, vancouver, were unable to participate in the clinical geriatric care activities due to the covid- pandemic. the ongoing industrial strike action embarked by the academic staff union of universities in nigeria has further worsened the situation as all forms of training in federal universities have been grossly affected. the impact on the effective training of dental students in nigerian universities is likely to be severe, further worsened by the highly contagious nature of the covid- infection in clinic settings by the time dental schools in nigeria reopen. previous studies among nigerian dental students had highlighted the importance of feedbacks from students on the factors that affecting their training and how these could be overcome. [ ] [ ] [ ] the covid- pandemic presents with a new range of challenges for undergraduate dental training, not only in nigeria, but worldwide which include infection control practices in the clinic. understanding these challenges will assist and guide dental faculties in assisting dental students through these very difficult times. the aim of this study was therefore to assess the knowledge, perception and attitude to the covid- pandemic and infection control practices among undergraduate clinical dental students in nigeria. ethical approval for this study was obtained from the health research ethics committee of the lagos university teaching hospital. the ethical approval number for the study is luthhrec/erev/ / . this was a descriptive cross-sectional study in which the study population was made up of undergraduate clinical dental students in their penultimate (year ) and final years (year ) from out of the accredited dental schools in nigeria. the estimated population of undergraduate clinical dental students in nigeria is , as they constitute a smaller segment of all undergraduate dental students in the country. the sample size of the participants for the study was determined to be using a confidence level of % within a % margin of error. informed consent was obtained from all respondents in the study. self-administered questionnaires were distributed and sent out repeatedly to participants using an online data collection platform (google forms), between april and june , using a purposive sampling technique. the respondents were accessed through their whatsapp general dental students' platform and direct whatsapp messages. the questionnaire had sections. section documented the participants' sociodemographic characteristics while section recorded participants' knowledge of covid- . correct responses were assigned point while incorrect answers were assigned . forty-five (n = ) questions were used to assess the students' knowledge of covid- . the total knowledge score was derived based on the total sum of correct responses and converted to percentage scores. the level of knowledge of covid- was categorized into : adequate and inadequate, using a cut off value of % considering the fact that covid- is still a novel disease. the third section appraised their perception and attitude towards infection control practices in the dental clinic using questions. participants' attitudes were assessed using a -point likert scale ( = strongly disagree; = disagree; = indifferent; = agree; = strongly agree). all the scores were summed up and converted to percentages. the average percentage perception score was then computed. scores ≥ % were graded as positive attitude towards infection control. data analysis was carried out using the statistical package for social sciences version . descriptive statistics was used for categorical variables that were expressed as frequencies and percentages, while student's t test was used to compute the means and standard deviation of continuous variables such as the age. the likert scales were collapsed into categories: disagree (scales , ), neutral (scale ), and agree (scales , ) for purpose of the statistical analysis. differences between categorical variables were compared using the chi-square or fisher's exact where indicated. the level of statistical significance was set at p ≤ . . a total of undergraduate clinical dental students participated in the study. males were slightly more ( . %) than females ( . %). the mean age of the respondents was . ± . years (range of - years). majority ( . %) of the respondents were in their final year. students in out of the dental schools participated in the study and distribution is as follows: university of lagos- ( . %); obafemi awolowo university- ( . %); university of maiduguri- ( . %); university of nigeria nsukka, enugu- ( . %); university of benin- ( . %); lagos state university- ( . %); university of ibadan- ( . %); university of medical sciences, ondo- ( %); and bayero university of kano- ( %). the mean overall knowledge score was . ± . . overall, ( %) demonstrated adequate knowledge of covid- . a significant proportion of the respondents ( . %) reported that they were up to date on the case definition for covid- . figure shows the source of infor-f i g u r e sources of information about covid- among the respondents in the present study mation about covid- , which is the primary data collected among the respondents during the present study. their source was mostly from the social media ( %), television ( . %), friends/family ( . %), colleagues ( . %), and text message ( . %), while the least source of information came from academic training courses ( . %). the social media in this study included twitter, facebook, instagram, youtube, etc., while the text message was the short message service (sms) through phone which was utilized mainly by the nigerian center for disease control (ncdc) to disseminate covid- related information. academic training courses on covid- that were freely organized by health organizations/bodies, locally and internationally, were accessible to the respondents in this study through different online platforms. table shows the responses of the respondents to the questions on covid- . nearly % of the students correctly identified sars-cov virus as the cause of covid- while majority ( . %) knew the average incubation period as - days. only . % of the respondents knew that mild to moderate symptoms occurred in % of those infected with covid- , while . % knew that asymptomatic people could spread the coronavirus. transmission routes of covid- were reported as respiratory droplets from coughing, sneezing, and talking ( %), and airborne ( . %). some of the symptoms of covid- known by the respondents included shortness of breath ( %), cough ( %), fever ( . %), loss of smell or taste ( %), joint/muscle pain ( . %), chills ( . %) and diarrhea ( . %). the sample collection methods to diagnose covid- was reported by . % as real-time pcr with nasopharyngeal swab/sputum and . % as real time pcr with endotracheal aspirate. only . % of the respondents knew the (figure ) . table shows their perception/attitude towards infection control. their responses included the perception that the current standard of infection control measures in their dental schools were effective in preventing the spread of covid- ( . %). majority ( . %) agreed that aerosol-generating procedures in dentistry carried a high risk of spreading covid- . regarding their attitude, . % were willing to undergo an infection control training in dentistry for covid- while only . % were willing to personally procure extra personal protective equipment (ppe) for use in the dental clinic to prevent the spread of covid- . table shows the association between knowledge of covid- and sociodemographic characteristics, and perception/attitude towards infection control practices against covid- . only the year of study was significantly associated with the knowledge of covid- , as the final-year students ( . %) demonstrated more adequate knowledge of covid- than the penultimate-year students ( . %) (p = . ). the rapid surge in the number of cases during the covid- pandemic has placed enormous strain on health care systems and significantly impacted educational systems globally, including dental training institutions in health care settings of undergraduate dental students. there are currently about accredited dental schools in nigeria. prior to the covid- pandemic, studies by isiekwe et al. - among undergraduate dental students in nigeria observed a lack of satisfaction with the quality of their clinical training. this study sought to provide an overview of dental students' knowledge of covid- and attitude to infection control during this pandemic, which could serve as guidelines in preparation for school resumption and clinical training of the students. the present study revealed that generally, only half of the students had adequate covid- related knowledge. on the contrary, majority had a positive attitude who reported a large proportion ( . %) of university students in china with good knowledge of covid- . a possible reason for the differences observed may be the fact that fewer questions were used in that survey ( questions) compared to our present survey which had many more questions on covid- ( questions). it is thus most likely that more information was required from the students in the present study. clinical dental students are expected to possess an in-depth knowledge particularly due to their access to the social media and television which were their most frequent source of information in the present study. the proportion of respondents with adequate knowledge of the diagnosis, case definition, symptoms (like diarrhea, joint/muscle pain, loss of smell, chills, headache), and at-risk persons was observed to be low. this could be ascribed to the novelty of the infection and the rapidly evolving information concerning its epidemiology. in this study % of the participants knew the correct incubation period of covid- , which is contrary to the findings of khader et al., who reported that only . % of dentists in jordan knew the correct incubation period. the news media in nigeria has been flooded with regular and continuous information from the ncdc (nigerian centre for disease control) on the need for self-isolation for a period of days for people who developed specific symptoms such as cough, fever, and breathing difficulties. this would no doubt have increased the respondents' awareness about these common symptoms, as the news media was bombarded by campaigns to identify these symptoms. besides, the jordanian study was conducted at an earlier stage of the pandemic, which might have accounted for the disparity in knowledge level of the correct incubation period. the majority of the dental students knew the early and common features of the infection; this finding is crucial as students should be able to easily identify a suspected ta b l e association between knowledge and socio-demography, perception, and attitude towards infection control practices against covid- case and take the necessary immediate action and respond appropriately. this was also the case in a jordanian study amongst dentists. the respondents in the present study indicated good knowledge of the preventive strategies for covid- . however, it was surprising to observe that the minimum social/physical distance of m (equivalent to feet) recommended by the who was unknown by the majority in the present study. a distance of at least m (about arms' length) between people has also been advocated by other health authorities such as the u.s. centers for disease control and prevention. it is important to maintain the recommended distance to prevent a person from inhaling droplets from someone with covid- who may be either asymptomatic or with symptoms of coughing, sneezing, or speaking. knowledge of bronchoalveolar and endotracheal aspirate for diagnosis was poor, however. this finding may be attributed to the most frequently used methods in this environment, which are oropharyngeal and nasopharyngeal swabs. although nasopharyngeal swabs have typically been used to confirm clinical diagnosis of covid- , a chinese study found bronchoalveolar fluid to have the highest positivity ( %), followed by sputum ( %), nasal swabs ( %), pharyngeal swabs ( %). the respondents' knowledge of hydrochloroquine/azithromycin and remdisivir was particularly impressive compared to that of pluristem and ivermectin. this may be due to the several controversies that have been generated regarding the effectiveness of these drugs, especially the antimalarial drug chloroquine and its derivative hydroxychloroquine, which the who is testing in some clinical (solidarity) trials in which nigeria is participating. the higher knowledge demonstrated by the final-year compared to the penultimate-year students could stem from a greater urge to learn more about the coronavirus and a deeper concern, eagerness, and anticipation amongst the final-year students to complete their clinical procedures upon school resumption in order to write the qualifying exams. it would therefore not be unexpected by them to want to learn more about covid- . these findings highlight the need to improve the knowledge span of undergraduate clinical dental students about covid- in order to mitigate its spread. this should be included in the curriculum for dental students all over the world. this is crucial, as the current approach to covid- is to control the routes of infection and to conduct extensive infection prevention and control (ipc) trainings with preventive measures to lower the risk of transmission. surprisingly, knowledge did not influence the attitude of the students significantly in this study. however, it was noted that there was a lack of will by most students to personally procure extra ppe to prevent the spread of covid- , when they recommence their clinical procedures. these materials are currently scarce in the market and quite expensive too, and many students may lack the funds to procure them. besides, there could be a notion that the school authorities are to provide these items. undergraduate dental education in nigeria is heavily subsidized by the government, with almost all the dental schools located in either federal or state government-owned universities. thus, students pay very minimal tuition, however, they are expected to purchase most of the bench items required for training. furthermore, since the dental schools are dependent on the government for most of their funding, they often have restrictive finances due to limited funding from the government. the provision of ppe by the dental school may therefore be an additional financial burden; in this context, without additional help from the government, the dental schools may be constrained to ask the students to procure their own ppe for training. this underscores the critical need by stakeholders to make appropriate ppe available for all undergraduate clinical dental students to curtail the spread of covid- particularly in resource restricted countries like nigeria. government and all stakeholders in the health and educational sectors must cooperate to fight this deadly scourge ravaging the whole world. majority of respondents ( . %) agreed that wearing of face masks, gloves, goggles, and face shields while performing dental procedures will protect against covid- . this observation is similar to effective infection control advocated in china by meng et al. it was encouraging to note that most of the respondents recognized that it was not advisable to wear the same clothing and footwear between the clinic and their hostels. approximately % of respondents strongly agreed that wearing clinical scrubs with protective footwear without their personal clothes when treating patients or observing procedures in the clinic gives better protection against covid- than wearing clinical white coats on top of their personal home clothing. this is in keeping with standard infection protocols to avoid transmitting infections. the role of health care worker's uniforms on the horizontal transmission of pathogens in hospital settings is controversial. in the study by munoz-price et al., they found an association between the contamination of providers' hands and contamination of white coats, yet they found no association between providers' hands and scrubs although this was mainly attributed to the reduced frequency of laundering white coats than the scrubs. prior to the pandemic, white clinical coats were worn over personal clothes by clinical dental students in nigeria during school hours in the dental clinics. this may however not be appropriate nor sufficient particularly with the highly infectious nature of covid- and might change when the students resume to school. advocating the wearing of clinical scrubs and foot wears was supported by most of the students in the present study. it would also equally important to emphasize the frequent laundering of the scrubs and foot wears. of note is the significant proportion of students supporting the need to change and wash their clinical white coat after daily use. thus, it should be performed regularly and thoroughly as it is a simple but effective measure that dissolves the lipid coat surrounding the virus and kills or inactivates the virus if the hands have been contaminated. , , in addition, in the present study, the perception held by many of the students was to pause the dental treatment of patients who start sneezing or coughing persistently in the dental clinic and refer them for further screening and possibly a covid- test. this is in tandem with the who policy that procedures which are likely to induce coughing should be avoided (if possible) or performed cautiously. , , the importance of hand hygiene as one of the most critical factors for reducing the risk of transmission of covid- has been previously reported. , thus, it should be performed regularly and thoroughly as it is a simple but effective measure that dissolves the lipid coat surrounding the virus and kills or inactivates the virus if the hands have been contaminated. , concerning the dental management of covid- patients, . % supported their treatment in a wellventilated room or in a negative pressure room. it is better and advised to encourage good air flow whilst ensuring physical distancing as much as possible. meng et al., proposed that based on their experience, relevant guidelines, and research, dentists are to take strict personal infection control measures that are effective and avoid or minimize operations that can produce droplets or aerosols. four-handed technique is considered beneficial for controlling infection coupled with the use of saliva ejectors with high volume to reduce the production of droplets and aerosols. the nonprobability sampling method employed in the study may be subject to selection bias as participants were approached via online platforms. environmental factors in each dental school may have influenced the responses recorded as each dental school has its own peculiarities. notwithstanding, this study has provided a national perspective on the knowledge and attitudes/perceptions of undergraduate clinical dental students towards the covid- pandemic and infection control practices in nigeria. this study determined that only half of the undergraduate clinical dental students had adequate general knowledge of covid- . the students were not abreast of current updates on covid- , particularly the confirmed case definition and less common symptoms. the students however had a good perception and positive attitude towards infection control practices against covid- . our recommendations are that guidelines from reputable health institutions/authorities on covid- be reviewed by the dental school authorities and included in the dental school curricula. the government should also make more ppe available for clinical dental students. the authors declare no conflict of interest. kehinde adesola umeizudike bds, mph, fmcds https: //orcid.org/ - - - x outbreak of pneumonia of unknown etiology in wuhan, china: the mystery and the miracle the epidemiology and pathogenesis of coronavirus disease (covid- ) outbreak covid- ) situation report . world health organization web site covid- ) situation report . world health organization web site nigeria centre for disease control web site covid- guidance for dentistry. california department of public health web site cdc guidance for providing dental care during covid- general dental council web site nda recommendations on covid- protocol for dental clinics. nigerian dental association web site salivary glands: potential reservoirs for covid- asymptomatic infection aerosol and surface stability of sars-cov- as compared with sars-cov- coronavirus disease (covid- ): emerging and future challenges for dental and oral medicine covid- pandemic: students' perspectives on dental geriatric care and education nigerian dental students' perspectives about their clinical education. unilag undergraduate dental education in nigeria: perceptions of dental students and recent dental graduates perception of dental students and recent graduates of a nigerian dental school on the quality of undergraduate training received. unilag knowledge, attitude and practice associated with covid- among university students: a cross-sectional survey in china dentists' awareness, perception, and attitude regarding covid- and infection control: cross-sectional study among jordanian dentists health topics: coronavirus world health organization (who) web site covid- ) social distancing, quarantine, and isolation. centers for disease control and prevention web site detection of sars-cov- in different types of clinical specimens effectiveness of use of chloroquine/ hydroxychloroquine in covid- case management. . world health organization web site differential laundering practices of white coats and scrubs among health care professionals nigerian undergraduate dental students' knowledge, perception, and attitude to covid- and infection control practices key: cord- -bwiyp e authors: abdulmajeed, kabir; adeleke, monsuru; popoola, labode title: online forecasting of covid- cases in nigeria using limited data date: - - journal: data brief doi: . /j.dib. . sha: doc_id: cord_uid: bwiyp e the novel coronavirus disease (covid- ) was first identified in wuhan, china in december but later spread to other parts of the world. the disease as at the point of writing this paper has been declared a pandemic by the world health organization (who). the application of mathematical models, artificial intelligence, big data, and similar methodologies are potential tools to predict the extent of the spread and effectiveness of containment strategies to stem the transmission of this disease. in societies with constrained data infrastructures, modeling and forecasting covid- becomes an extremely difficult endeavor. nonetheless, we propose an online forecasting mechanism that streams data from the nigeria center for disease control to update the parameters of an ensemble model which in turn provides updated covid- forecasts every hours. the ensemble combines an auto-regressive integrated moving average model (arima), prophet - an additive regression model developed by facebook, and a holt-winters exponential smoothing model combined with generalized autoregressive conditional heteroscedasticity (garch). the outcomes of these efforts are expected to provide academic thrust in guiding the policymakers in the deployment of containment strategies and/or assessment of containment interventions in stemming the spread of the disease in nigeria decision sciences application of an online framework for forecasting the range of covid- cases in nigeria using limited data. the dataset is in raw excel file format, has been cleaned, analyzed in this article, and is available in the mendeley data repository. the ensemble algorithm presents lower and upper bounds for the total number of possible covid- cases for the next day. arima, prophet, and holt-winters models were implemented and tuned using brute search. data on the daily number of covid- cases in nigeria were automatically mined from the ncdc and wikipedia websites every hours. the dataset contains covid- cases starting from february , , to april , . descriptive analysis of the dataset has been presented and the forecasts using limited data are made available. sample code to mine real-time covid- cases in nigeria as a pandas data frame or excel file has been provided in the repository. osun state university, osogbo, osun state, nigeria. the data at the point of writing and code can be found in the mendeley repository. value of the data  these data are useful as they present facts that drive analytics on covid- cases in nigeria.  academic institutions, public health agencies, scientific communities, researchers, students, and self-explorers can use these data, code, and models to analyze covid- cases in nigeria and beyond.  the data -with daily updates, model, code, and analysis presented can be applied to drive analytics, policy development, and decision making in other countries where data is scarce. it also represents an early reference that can be used in the future.  the ensemble of models leverages the strengths and compensates for weaknesses in the individual forecasting algorithms even with limited data. the daily number of covid- cases in nigeria from february , , to april , , were automatically mined every hours from the official websites of ncdc (http://covid .ncdc.gov.ng/) and wikipedia (http://tiny.cc/nigeria_covid ) using a python script. the case numbers up to april can be found in the supplemental data (appendix a). as at the point of writing this brief, the dataset contains time-series data points. for forecasting purposes, earlier days with zero incidences of covid- were filtered for building the forecast models. this is presented in tabular form in table - and visual form in fig. while the number of new cases per day is shown in fig. . seven successive daily forecasts by the ensemble, starting from march , , to april , , are presented in table . the autocorrelation and partial autocorrelation behavior of the dataset of fig. aids in developing arima modeling insights. similarly, fig. is a visualization of the forecast beams indicating the direction and strength of increases or decreases in the forecasted number of cases. table highlights the relative strength and weaknesses of the models individually and finally; fig. presents a visual comparison of covid- cases in nigeria vs south africa for analyzing policy impact. in this paper, we present the application of ensemble forecasting models in a data constrained environment. the objective is to establish the lower and upper bounds on the possible number of covid- cases per day using a framework that automatically streams web data in real-time from reliable sources. this data is used for retraining and adapting the parameters of an ensemble of three models which in turn updates its forecast prediction for the following day. each of the three models provides an estimated lower bound and upper bound for the number of cases. the ensemble forecast is achieved by taking the minimum of the lower bounds and the maximum of the upper bounds. due to limited sources of data (the only available information is a single variable, "number of covid- cases per day"), it makes it difficult to implement specialized, advanced, and more generalizable methods that often require a variety of features and bigger datasets. it is also important to highlight that there are only a few samples ( ) represents the series of differences, are the coefficients, the and are the lagged predictors for the model [ ] . the arima model is a generalization of many sub-models and characterized by three parameters: order of autoregressive observations , degree of differencing , and number of moving average terms . the foundations of arima lie on the fact that nonstationary time-series can be made stationary by through differencing. the verification of stationarity can be achieved using autocorrelation plots and unit root tests such as the kwiatkowski-phillips-schmidt-shin (kpss) test [ ] . for this model, we are interested in non-seasonal phenomena. using brute search and inspection of the autocorrelation function acf and partial autocorrelation function pacf plots (figure ) , an arima ( , , ) model was chosen. ii. prophet is an additive regression time-series forecasting algorithm developed by facebook [ ] , [ ] . it has strengths in dealing with strong seasonal effects, missing data, outliers, and shifts in trend making it fully automatic. it is also implemented with a stan backend which introduces a fast solution to l-bfgs (limited-memory broyden-fletcher-goldfarb-shannon algorithm) for the forecasting problem. prophet includes a decomposable time series model defined by: is the trend, represents seasonal changes and captures irregular effects. we elicit trend characteristics as of primary importance in developing the forecast. the trend model in this work utilizes a piecewise saturated growth model with time-varying carrying capacity defined below: is the time-varying carrying capacity, is the growth rate, is an offset. the growth rate is not constant but piecewise with , , and defining its structure. iii. holt-winters exponential smoothing is a famous time-series modeling and forecasting algorithm that came to light in the s after some scientific reports [ ] [ ] [ ] . this algorithm is a weighted average of past observations with exponentially decaying weights to capture the trend in a time-series dataset. it has the general form of: where the values of alpha tune the response of the model. alpha values close to emphasize past input data, while values close to emphasize recent input data. the holt-winters es algorithm introduces a seasonality component to the vanilla es. in addition to the es model, a garch model [ ] was used to forecast variances and combined with the es model gives the upper and lower bound for this model iv. forecasts: in table , the dates for each of the forecasts along with the corresponding acutal reported (official) cases by ncdc can be observed. the performance of the ensemble models can easily be visualized in figure . the forecast envelope accurately captures the actual number of real cases detected by the ncdc. by combining these three algorithms, we compensate for their relative weaknesses while reinforcing their relative strengths (table ) . ultimately, we believe in the mantra that all models are wrong, but some are useful -george box. no readily known weaknesses strong and accurate forecasting (short-term), favors recent data samples, requires few data points, straightforward implementation. lagged forecasts. although, there is more information on the covid- situation in north america, europe, and asia in comparison with nigeria. figure presents the comparison of covid cases in south africa (sa) with nigeria (ng). the figure shows that the number of confirmed cases of the infection in sa in geometrically higher than ng. this observation could be explained from two perspectives: (i) sa either has much more people infected with covid- than ng; (ii) or there is wider coverage in the number of people test per day among the population. the latter reason may probably be stronger than the former as there is corroboratory evidence for the later. as of the th march , sa had conducted , tests [ ] while nigeria only performed tests [ ] . one of the current strategies being deployed for the containment of covid- is the lockdown of regions affected to avoid further spread by human movement. we find evidence that this strategy is effective in the containment of the infection in sa. sa declared a national lockdown on the th of march, [ ] to tame the spread of infection. as shown in figure , there was a kink in the progression of confirmed cases on march , . the steepness of the curve was relatively flattened and steady for a few days thereafter. the steep upward trend of the infections was stemmed the same day the national lockdown policy was announced. the fact that those that have been infected before the lockdown will be presenting themselves for tests and treatment could have accounted for a slight rise in cases within weeks of lockdown. the full compliance with the policy and number of new cases in post- -weeks lockdown policy are scenarios that would guide further actions in sa. it is difficult to model covid- (in fact, any real-life scenario) has inherent modeling difficulties such as the number of tests, randomness, interventions, stay-at-home compliance, curfews, epidemiological realities, and many other factors contribute to the difficulty of forecast models in this case. countries, especially in africa who are just witnessing a progressive rise in covid- cases must be decisive in implementing the containment interventions and ensure strict compliance by the citizenry. nigeria center for disease control forecasting: principles and practice testing the null hypothesis of stationarity against the alternative of a unit root forecasting at scale prophet statistical forecasting for inventory control forecasting seasonals and trends by exponentially weighted averages forecasting sales by exponentially weighted moving averages generalized autoregressive conditional heteroskedasticity coronavirus testing -source data an update of covid- outbreak in nigeria ramaphosa announces -day coronavirus lockdown for south africa the authors acknowledge the abdulmajeeds for their encouragement throughout this work. special appreciation to the management of osun state university for the support of this project. the authors declare that they have no known competing financial interests or personal relationships which have, or could be perceived to have, influenced the work reported in this article. supplementary data to this article, daily updated data, and data mining code can be found online using the mendeley repository http://dx.doi.org/ . / xsb nyfhp. . updates can also be monitored at the github repository https://github.com/kbmajeed/nigeria_covid key: cord- -v rnvpg authors: orunmuyi, akintunde t; lawal, ismaheel o; omofuma, omonefe o; taiwo, olalekan j; sathekge, mike m title: underutilisation of nuclear medicine scans at a regional hospital in nigeria: need for implementation research date: - - journal: ecancermedicalscience doi: . /ecancer. . sha: doc_id: cord_uid: v rnvpg background: nuclear medicine needs better integration into the nigerian health system. to understand the relevant public health initiatives that will be required, this study assessed the pattern of nuclear medicine imaging services at the first nuclear medicine centre in nigeria from january to december . methods: the data of consecutive nuclear medicine (nm) scans performed between st january and st december at the nm department in a tertiary hospital in nigeria were extracted from patient records and analysed using sas version . (sas institute, cary, nc). the national cancer institute’s joinpoint software and qcis (qgis project) were used to estimate imaging trends and geographical spread of patients. results: an average of scans per year was performed during the study period. patients travelled from of nigeria’s states, and the majority ( %) travelled more than km to obtain nm scans. bone scans accounted for . % of the studies. the remainder were renal scintigraphy ( . %), thyroid scans ( . %), whole-body iodine scans ( . %) and others ( . %). conclusions: nm in nigeria appears underutilised. furthermore, the studies to characterise the access gaps and implementation needs will contribute to the design of practical strategies to strengthen nm services in nigeria. the availability of nuclear medicine in sub-saharan africa has increased significantly in the past two decades [ ] . whilst south africa has the most advanced nuclear medicine (nm) practices on the continent, spanning over six decades, the growth of nm in most of the other sub-saharan african countries is a recent event [ , ] . nm diagnostic and treatment procedures are among the most powerful analytic tools for decision-making in the management of cancer, cardiovascular and neurological diseases. appropriate utilisation of nm tools has led to fewer patients undergoing invasive and costly tests and sometimes unnecessary treatments including invasive surgeries [ ] . the impact of nm on the management of cancer led to the strengthening of nm capacity by the international atomic energy agency (iaea) among member states in africa, as a part of international cancer control efforts [ ] [ ] [ ] [ ] [ ] . however, the growth of nm in sub-saharan africa continues to face many challenges. the known barriers include ageing equipment [ ] , culturally embedded dread of radiation [ ] , logistic challenges with radionuclide delivery [ , , ] , lack of health insurance [ ] , as well as other systemic barriers that limit health systems in developing countries [ , ] . the incidence of cancer is increasing in most of the african countries [ ] [ ] [ ] [ ] . the demographic and epidemiological changes are leading to a rise in the non-communicable disease burden on public healthcare in nigeria, africa's most populous country [ ] . as a part of the national strategic health plans, nm planners in nigeria projected that the country would require a minimum of nm centres to provide equitable access to nm services in the country. using their intuitive judgement, the sites of the ten nm centres were in tertiary hospitals that will provide radiation oncology services [ ] . having received a grant from the iaea, the centre under review was established in as the first nm centre in nigeria. it is geographically located in the southwest region of the country at nigeria's first tertiary hospital and oldest medical school [ ] . the second centre was opened in at the nation's capital city, which is geographically in the northern central region of the country. both centres have a similar complement of nm physicians, which are in tertiary hospitals and major regional referral centres for radiotherapy. however, the centre under review is more established with four radiopharmacists, a dedicated medical physicist and two gamma camerasincluding the only hybrid single-photon emission computer tomography/computer tomography (spect/ct) scanner in west africa [ ] . furthermore, it is purpose built to accommodate two positron emission tomography (pet) scanners and a cyclotron and recently expanded from two to ten isolation rooms for radionuclide therapy, making it the largest nm facility in the country. the second centre is equipped with a double-head spect camera and has two radiopharmacists and two nm physicians. for unknown reasons, nm services have been interrupted for prolonged periods in the past years. as a result, opportunities to scale up existing capacity, create a better understanding of the benefits of nm and invest in research and education to support its growth in nigeria are desired. to inform the relevant public health initiatives that will be required to promote nm in nigeria, this study assessed the pattern of nm imaging services at the first nm centre in nigeria from january to december . the medical records of consecutive patients who underwent nm scans at the department of nuclear medicine at the university college hospital, ibadan, between january and december were retrospectively reviewed. the data on approximately , studies from to had been lost due to damage to the external hard drive for image storage and several missing pages on the data entry book. we collected sociodemographic and clinical information including age, sex, residential address, referral details, type of scan each patient received and the indication for the scan. a paediatric patient was defined as any patient aged years or younger at the time of imaging. furthermore, categories were created for age (missing, ≤ years, - years, - years, - years, - years, - years or ≥ years ), sex (male or female), type of referral hospital (in-hospital and outside hospital), type of scan, indication for referral (cancer related or non-cancer related) and referral physician speciality (unknown, surgical speciality, medical speciality, radiation oncology, paediatrics or others). the human research ethics committee of the institution approved this study, ethics number ui/ec/ / , and waived the need for patients consent due to the retrospective design of this study. the national cancer institute's joinpoint software was used to estimate the annual percentage change (apc) in imaging/scans from to . referral patterns were characterised by the type of referral hospital and referring physician speciality. the residential address provided by patients was used to determine the state of residence in nigeria. subsequently, the geospatial data were generated from the centroid coordinate of each state in nigeria and was obtained from a digital map of nigeria. new columns (latitude and longitude) were created, and the corresponding centroid coordinate of each patient was added. the file was saved as a text file and imported into the open-source qgis software. the distance to the nearest hub algorithms was implemented based on the data. subsequently, the distance travelled to obtain nm scans was estimated. a km distance was empirically chosen to categorise the distance travelled to obtain scans into two groups (≤ km or > km). we performed all scans in accordance with the international guidelines as published by the european association of nuclear medicine and the society of nuclear medicine and molecular imaging. procedures were characterised according to the common single-photon emission computer tomography (spect) scan types (bone, renal, thyroid or whole-body iodine scans or others). less commonly requested spect scans include brain, cardiac, lung and gastrointestinal (gi) scans and were grouped under the category 'others'. indications for nm scans were further subclassified as follows: common oncologic (cancers of the breast, prostate, cervix and gi tract), less common oncologic (all other cancers) and non-oncologic indications. descriptive statistics were assessed for the means and standard deviations (sd) for continuous variables, whereas the percentages were assessed for categorical variables. all statistical analyses were conducted using sas version . (sas institute, cary, nc) and the national cancer institute's joinpoint software. a statistical significance was set at p < . . a review of the medical records showed that a total of , nuclear medicine scans were conducted between january and december at the university college hospital, ibadan. these scans were performed in , patients. a total of repeat/follow-up scans were performed in patients, ranging from to scans per patient. table shows the general characteristic of patients. the mean age was . ± . years (range: . - years), and % were done in females. the highest proportion of nuclear medicine scans was conducted in persons aged between and years ( . %). the paediatric age group accounted for . % of scans performed. patients travelled from all but four states in nigeria (figure ), and most ( %) travelled more than km to obtain scans ( figure ). figure shows the speciality of referring physicians during the study period. surgical specialities and radiation oncology accounted for % and . % of total referrals, respectively. bone scanning with technetium- m ( m tc)-labelled diphosphonates was the most common procedure ( . %), followed by renal scans ( . %), whereas pertechnetate thyroid scans and whole-body iodine (wbi) scans using radioactive iodine- ( i) accounted for . % and . % of scanning procedures, respectively (table ) . overall, . % of scans performed were for oncology indications. table shows the common and less common oncology indications for scans. female breast cancers ( . %), prostate cancers ( %), cervical cancers ( . %) and gi cancers ( . %) were the top four. among the less common oncologic indications, head and neck cancer was the most common, also accounting for . % of overall scans. only scans were carried out for non-oncologic indications and are shown in table . renal scans ( %) were the most common nononcologic scans, followed by bone ( . %) and thyroid ( %) scans. less commonly performed non-oncology scans during the study period included hepatobiliary scans using m tc-labelled iminodiacetic acid derivatives, parathyroid scans using the cardiac imaging agent mibi (hexakis methoxy-isobutyl-isonitrile), lymphoscintigraphy and gastric emptying scan. technetium-labelled mercapto-acetyl-triglycine ( m tc-mag ) and technetium labelled-diethylenetriaminepentaacetic acid ( m tc-dtpa) accounted for % of renograms, whereas the remainder were m tc-dmsa scans (technetium- m-labelled dimercaptosuccinic acid). furthermore, an evaluation of non-oncologic indications for scans showed that that scans for the evaluation of pain/inflammation were the most common non-oncologic bone scan followed by scans to evaluate for infection. notably, all requests for infection imaging were from in-hospital orthopaedic surgeons. the trends of scans performed from to showed a significant increase in the apc of renal and thyroid scans by . % and . %, respectively. conversely, bone scans decreased by . %, but this was not statistically significant. furthermore, the analysis of the trend for bone scans showed a significant decrease in the apc for breast cancer ( . %), whereas bone scans for prostate cancer increased by . %. overall, a significant decline in in-hospital requests (apc: . %) and an increase in outside hospital requests (apc: . ) were noted (p < . ). the trend data are shown in figures - . this is the first study reporting on nm utilisation and referral patterns in nigeria, the most populous african nation [ ] . the volume of scans averaging scans per annum is consistent with the other studies reporting similar low throughput of nuclear medicine departments in sub-saharan africa [ , ] . besides the specific barriers of nm in nigeria [ , [ ] [ ] [ ] [ ] , general challenges that affect oncology and healthcare delivery significantly impact on nm scans. since the majority of the referrals come from oncologists, radiotherapy equipment downtime and industrial strike actions by health professionals trade unions impact on nm services [ ] . external strikes (aviation and logistics) are not only less frequent but also halt nm service delivery. for instance, since the global covid- pandemic started, an import of radionuclides from overseas has been disrupted. the affordability of scans also plays a major role in the utilisation of nm procedures in nigeria [ ] . in our experience, camera downtime as a factor for under utility of nm is infrequent. its effects are minimised due to the availability of two gamma cameras. the low utility of nm scans could be partly explained by the accessibility of services. with only two centres nationwide, patients would have to travel long distances to obtain services [ ] . although patients travelled from all but four states in the country, the numbers of scans diminished with distance travelled (figure ). the four states without referrals are a part of six states in nigeria with remarkably high rates of severe malnutrition [ ] . therefore, it is likely that travel distance and socioeconomic factors play a role in the utility of nm services. this could be evaluated in the further studies. the results show that few nm scans were performed for non-oncologic indications. remarkably, no cardiac imaging was conducted during the period under review. the absence of nuclear cardiology imaging may have contributed to the low scan volumes in this study. nuclear cardiology, in general, notably stress myocardial perfusion using single-photon emission computed tomography (spect), is underutilised in many developing countries [ ] [ ] [ ] . myocardial ischaemia appears to be an infrequent cause of hospital deaths in nigeria despite population-level changes in cardiovascular disease mortality and morbidity [ ] [ ] [ ] . the ability to foster the adoption and expansion of nuclear cardiology in developing countries may be blunted by the marked decline of spect cardiology imaging globally [ ] . infectious diseases continue to be the leading cause of mortality in sub-saharan africa [ ] . this proposes that the need for infection imaging will be high. the utility of nm for infection imaging was low and limited to referrals from in-hospital orthopaedic surgeons. although in-house orthopaedic surgeons are renown experts in the country and more informed about nm services [ ] , we do not believe that they are utilising nm scans to the maximum possible. feedback of their dissatisfaction with bone scans for the evaluation of prosthetic joint inspired efforts to introduce technetium-labelled ubiquicidin peptide ( mtc-ubi). however, the local research studies to evaluate its impact are required. conducting research has been shown to facilitate the adoption of new techniques in small-scale initiatives [ ] . given the recent development of infection-specific radiopharmaceuticals such as mtc-ubi [ ] , advances in spect quantification and standardisation of imaging procedures [ ] , the approaches to raise awareness about nm infection imaging and its potential adoption are needed. overall, the low utility of nm for non-oncologic scans may not be unrelated to the promotion of nm at its founding as an important tool for cancer management [ , ] . furthermore, the studies to explore other unknown factors that play a role in the low throughput of nm services in nigeria and other sub-saharan african countries are warranted. implementation science has been proposed as a means to foster the adoption of evidence-based strategies for health in low-and middle-income countries [ , ] . investigating the challenges of implementation and adoption of nm in sub-sahara africa should not be overlooked. the predominant use of diuresis renography among adults in this study is noteworthy. it contrasts with the reports from developed countries, where diuresis renography is predominantly used in children for the early detection and management of congenital abnormalities of the kidneys and urinary tracts (cakut) [ ] [ ] [ ] [ ] . in nigeria, cakut is responsible for between . % and . % of paediatric admissions and a major cause of chronic kidney disease among children [ , [ ] [ ] [ ] . coordinated efforts to improve the diagnosis and treatment of renal diseases in childhood are needed and may impact on renal diseases observed in adulthood. opportunities for multidisciplinary research and coordination of public health paediatric care in proximity to nm centres should be explored further. the role of nm in thyroid disease continues to be of interest. the current role of thyroid scintigraphy for diagnosis is adjunctive [ ] . several radionuclides are used for thyroid imaging, where nm contributes to the treatment of both oncologic and non-oncologic conditions. radioactive iodine ( i) and pertechnetate ( mtco -) are the radionuclides used for imaging, whereas i is used for treatment. similar to the other reports, this study shows mtc-pertechnetate as the main isotope used for thyroid imaging in resource-poor settings. its major indication for use is to evaluate clinically confirmed graves' disease. other indications include evaluation of thyroid nodules and thyroiditis to locate ectopic thyroid tissue [ , ] . its low cost, ready availability, rapid imaging and lower absorbed dose are major advantages. for patients undergoing radioactive iodine therapy for benign and overactive goitres, it is routinely used to guide empirical dosing [ , ] . however, personalised radioiodine therapy is best achieved by a radioiodine uptake test [ ] . radioactive iodine i therapy (rait) is the first targeted theragnostic radionuclide in nm and plays an important role in thyroid carcinoma treatment [ ] . the reports of the use of rait in nigeria predate the establishment of the nm imaging facilities [ ] [ ] [ ] . the rising patterns of thyroid and whole-body scintigraphy with i (wbi) in this study provide recognition for the impact of nm in nigeria. wbi is recommended for staging of patients with suspected metastases from differentiated thyroid carcinomas. the use of the same radionuclide ( i) for diagnosis and treatment has its controversies [ ] . however, it remains useful for identifying patients who will benefit from i from the other forms of therapy in the case of poorly differentiated or dedifferentiated thyroid carcinoma [ , ] . wbi provides information on nodal and distant metastases for staging of the disease and gives a visual representation for monitoring treatment response and detection of recurrence during follow-up [ , ] . therefore, the routine administration of radioactive iodine i without radionuclide imaging is not recommended [ , , ] . opportunities to educate oncologists/endocrinologist on the role of imaging for radioactive iodine therapy must be sustained. challenges with radionuclide supply continue to impact on timely access to nm services and its growth in nigeria [ ] . this may contribute to the observed stable imaging trends despite population health evidence shows the need for nm. the decline in bone scan for breast cancer may indicate the impact of evidence-based research on clinical practice. in a prior study, we had shown that bone scan was frequently showed metastases in patients with stage iii and iv disease. hence, the routine use of bone scan for staging is only in these patients [ ] . consistent with global patterns, bone imaging with technetium-labelled diphosphonates was the most common procedure in the centre. it is well established for staging of patients with prostate, breast, small-cell lung tumours and other cancers which frequently metastasise to bone [ , ] . the top four oncologic indications for nm scans in this study were consistent with country figures [ , ] . general advances in imaging are increasingly revealing the limitations of bone scanning, particularly for modifying treatment outcomes and early detection of treatment response in cancers [ ] [ ] [ ] . recent pet tracers are promising for the application of pet in the initial evaluation of several oncologic diseases [ , ] . since automated synthesis systems have increased the reliability, reproducibility and safety of radiopharmaceutical productions [ ] [ ] [ ] , the absence of pet services in nigeria is largely due to the high cost of investment. in the southern hemisphere of africa, the availability of pet is limited to south africa and, recently, kenya. recent advances in spect technology are projected to advance spect closer to pet imaging [ ] . however, it will require matching advances in spect radiopharmacy and affordability within the reach of low-resource countries. furthermore, the feasibility analysis on the need and utilisation of technological advances in nm technologies (cyclotron, pet, spect) in africa are warranted in the future. nuclear medicine in nigeria has been sustained for years but appears underexplored and underutilised. however, the limited availability of nm services creates unequal access for patients who require these services. differential and contextual factors contribute to the slow growth of nm in nigeria and increase the complexity of interventions that are required to boost it. furthermore, the studies to characterise the access gaps and implementation needs are desired. pragmatic steps to strengthen nm services in nigeria are critical to appreciate its potential beyond the current level of utilisation in the nigerian health system. no funding was received for this work. the authors declare no conflict of interest. nuclear medicine in africa promotion of nuclear medicine-related sciences in developing countries global issues of radiopharmaceutical access and availability: a nuclear medicine global initiative project trends in nuclear medicine in developing countries guest editorial: iaea approach to meet nuclear medicine needs of the emerging world adverse reactions to radioiodine i therapy of goiter in west african tertiary hospital mol imaging radionucl ther avoidable challenges of a nuclear medicine facility in a 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`asume' title: beyond transparency: a consideration of extraction's full costs date: - - journal: extr ind soc doi: . /j.exis. . . sha: doc_id: cord_uid: m m nk this special section beyond transparency: rethinking the government of extraction examines the relationship between international transparency discourse in the extractive sector, and the persistent association of unaccountable government, socioeconomic injustice and ongoing environmental hazards associated with extractive firms and their operations. our critical analyses of transparency- situate the discourse and practice within the overall turn-of-millennium regulatory capture of states in the global north - including canada, the us and the uk - by oil and mining industry interests. contributors probe how transparency regimes have been applied to oil and extractive sector ‘host states’ in the global south, in particular nigeria, while the rent-seeking practices that these regimes seek to expose are rarely tied to corporate malfeasance in the north. we employ this introduction to consider global transparency discourse and regulatory regimes in the light of the full cost of extraction. since the turn of the millennium, we argue, attention to extraction's full costs have been largely overshadowed in policy discourse via global transparency regimes, notably the extractive industries transparency initiative. since the second quarter of , as the covid- pandemic disrupted the global economic order and with much of the world under different levels of lockdown, the petroleum industry experienced a crisis more profound than any in the past century. the reduced demand for oil forced an unprecedented price crash with ramifications for the profitability of petroleum corporations and the financial markets with which they are co-constituted. the price of a barrel of oil dropped below production costs. in north america, as producers filled all storage spaces with unsold crude, the price per barrel dropped below $ . globally, the situation has threatened the revenues of exporting countries like nigeria, where prices fell below the estimated production costs of $ per barrel. as smaller oil firms declare bankruptcy, their ceos have pocketed exorbitant severance pay (mccormick ), akin to the corporate bailouts that followed the financial crash. the precarious, and low-valued, global oil market incentivizes a new round of critique of oil and gas parastatals such as the nigerian national petroleum corporation (nnpc) given the exceptionally lowprice of these assets in current conditions. in opening its historic books to scrutiny, the nnpc facilitates conditions for a possible sell-off (munshi, ) and attendant speculation, even while private sector activities remain shielded and privileged. this recent nnpc disclosure may be precipitous: the critical response to these sudden disclosures could prompt the crisis-induced sale of a public asset at conspicuously fire sale prices, as per naomi klein's ( ) 'shock doctrine' klein, . the unprecedented drop in crude oil prices also obfuscates the unresolved question of the full cost of extracting petroleum, a question which complicates transparency practices implemented by the oil and gas industry and state partners. inspired by nnimmo bassey's contribution to this special section, we employ this introduction to consider global transparency discourse and regulatory regimes in the light of this full cost of extraction bassey, . since the turn of the millennium, we argue, attention to extraction's full costs have been largely overshadowed in mainstream policy discourse via global transparency regimes, notably the extractive industries transparency initiative. the full costs of extraction entail the immediate ecological 'externalities' that residents of highly-polluted sites like the niger delta shoulder in toxic exposures leading to deterioration of the natural environment and agrarian livelihoods; furthermore these 'externalities' have caused profound climatic impacts globally. in sites where the oil and gas industry has been a central feature of economic organization, often reflecting global structural racism, extraction's full costs may also comprise physical violence perpetrated by state militaries and other armed groups. this violence has roots in communal divisions and mistrust stemming from industrial techniques for social control employed by corporations in imperial and (neo) colonial contexts. indeed, in countries like nigeria and venezuela, where oil exports sustain the economy, the price of crude oil has ramifications beyond the profitability of extraction, with implications for the survival of the regimes in power, and for broader nation-building challenges (coronil, ) . as we synthesize in this introduction, the contributors to this special sectionscholars and activists, center their analyses on examination of a decade of implementation of the extractive industries transparency initiative (eiti) and associated mechanisms in nigeria, ghana and canada. the social tensions and contradictions wrought by the oil industry came to international attention with the s exposé of ecological devastation in the sites of extraction in africa and latin america, and in indigenous people's territories in north america. the struggles of the ogoni in nigeria resonated with an apotheosizing northern environmental justice movement. the tensions experienced by southern communities at the time, and those of the indigenous justice movement in the north, often diverged from those of the mainstream of northern environmentalism. communities in resistance and social movements in the south demanded changes that were informed by understanding the interrelationship between (neo)colonial state power and big oil, seeking indigenous sovereignty and 'resource control', a dynamic concurrent with struggles such as those of the lubicon cree in north america. ogoni resistance compelled shell to pull out its operations in nigeria in as the nigerian state unleashed violence against community members (okonta and douglas, ; pegg ed ; okonta, ) . the outcry that followed ken saro-wiwa's murder with shell's complicity led to corporate re-regulation via a shell led 'corporate social responsibility' campaign (zalik ) , enshrined in that firm's publication 'profits versus principles: does there have to be a choice?" it was in this context that the extractive industries transparency initiative emerged as an elite-driven response to the oil industry's negative repercussions (haufler ) . as a voluntary initiative, it arose alongside the world bank's extractive industries review which aimed to address the reputational crisis that the industry faced (see hilson and maconachie ; osuoka and zalik ) . in the s, as social movement struggles around environmental and resource justice simmered in authoritarian regimes such as nigeria under abacha, policy researchers asserted that resource-dependent countries expressed a high risk for authoritarian and corrupt practices (moise ) accompanied by political instability, and weak social and economic indicators. influential social scientists described these traits as pathologies and their follow-on effects as a 'resource curse' (auty ; sachs and warner ) , wherein states with large extractive sectors, or particular subnational regions (manzano and gutierrez eds ), were constrained from mobilizing their societies for social and economic development. informed by historical and economic analyses of particular countries (mahdavy ; karl ) the resource curse approach led to the promotion of a set of international policy norms for 'good governance'; among these the transparency regime is a significant feature. although many critical scholars have questioned resource curse theory for its determinist implications (lahiri dutt ; watts ) influential academic and policy circles maintain that promoting state level transparency in the extractive sector should contribute to reversing negative social impacts of export commodity-dependence, in particular, the looting of public revenues (collier ; florini ; cuvellier, vlasenroot and olin ) . activists, too, anticipated that if companies must 'publish what you pay' to state institutions, citizens would be in a better position to hold their government to account. nevertheless, transparency practice has largely delimited policy debates to exclude the historical relations of extraction. longstanding critiques of these social relations (rodney ; girvan girvan / , including within west africa, suggest how the roots of dynamics understood as corrupt -including the use of state office to tranfer resources to limited social groupings -were shaped by the transatlantic slave trade, colonial indirect rule (ekeh, (ekeh, , and settler colonial extractive regimes. the extractive industries transparency initiative traces its own institutional history to the critiques of the resource curse that emerged in the late s. the eiti identifies a speech by tony blair at the johannesburg world summit on sustainable development as a key announcement, subsequently formalized at a conference hosted by the uk department for international development. financial institutions supported the initiative explicitly as a means to "improve corporate governance and reduce risk" arguing that it is in the interest of the companies that we lend to and invest in (to) operate in a business environment characterised by stability, transparency and respect for the rule of law. these factors are essential to securing economic prosperity and social cohesion, which, in turn, enable these companies to prosper. global civil society organization were also important actors, with the publish what you pay (pwyp) coalition growing out of a global witness report on angola. working mostly through pwyp, ngos advocated strongly for eiti implementation in global south countries and contributed to the enactment of enabling national legislations. this nominally tripartite approach to transparency governance persists in the eiti today. within the eiti system the compromise beween state, corporations and civil society (arond et al., ; sovacool et al., ) is heralded as the basis for arriving at disclosure practice. in recent years extractive industries and society has hosted important fora on the legacy of ken saro wiwa (ako, ; pegg, ) and the niger deltan struggles (naanen ; senewo, ) and for broader demobilization or fragmentation of movements. policy-directed work has considered the implications of the enactment of the eiti at the international scale for institutional change. our particular intervention in this special section seeks to address the space between these two sets of approaches. in essence the special issue interrogates the relationship between social struggles against the oil industry and the industry's global re-regulation through transparency discourse, including whose claims are disabled or enhanced through transparency's implementation regime. a key outcome of transparency discourse, in our view, has been to depoliticize contestation over the distribution of costs and the redistribution of windfalls by processes that 'render technical' (li ) and bureaucratize, an analytic key to contemporary critical development studies (ferguson ) . nigeria, arguably, has made 'revolutionary' strides in institutionalizing a rigorous domestic nigeria extractive industries transparency initiative (neiti) leading to major public disclosures in neiti audits. indeed, in nigeria received an award from eiti international for surpassing the minimum standard. yet as discussed by various contributors to this special section (adunbi, osuoka, nwadishi this issue), direct participants in the process hold that the neiti has neither contributed to the reduction of poverty nor enshrined accountability in the extractive sector, key objectives of its work. in contrast, the united nations environmental program (unep ) issued a major report on oil pollution in ogoniland in , revealing that the negative impacts of petroleum exploitation on the natural environment, human health and livelihoods in the niger delta are even worse than what was previously imagined and that shell, as the major operator in the area, has not upheld its own international standards. despite this major exposé of the oil industry's ongoing pernicious environmental impact in the niger delta, there has been no sustained action on the part of government (and civil society) to address it, underlying the limits of both transparency discourse and greater information disclosures to substantively improve the regulation of the extractive sector. this squares with institutionalist studies that conceptualize transparency regimes as 'governance by disclosure' (haufler ) and point to an at best murky relationship between transparency and substantive economic democracy (gupta and mason, ) . such broadly disappointing results prompt the contributors' examination of transparency discourse in practice, including its relationship to global financial regulation. the special section examines contradictions that emerge from re-inscribing the dominant neoliberal discourse wherein the global north promotes extractive sector 'good governance' in the global south through voluntary mechanisms, in the absence of a binding framework. frequently missing are the normative and power-political (mason, ) , contexts that determine the content and limits of disclosures under transparency regulation, including the (un)usefulness of such disclosures. thematically, we group the contributions to the section as revealing the limits of the transparency regime through a focus upon ) the calculation of industry's socio-ecological costs, ) the compromise between the market and civil society, ) the question of community accountability and ) the advance of corporate audit culture. collectively the contributions suggest that civil society/ state arrangements reconfigure hegemonic power rather than constituting a more radical basis for power. accordingly, the eiti fosters institutional procedures through which states, corporations and civil society mainstream nominal transparency within neoliberal business regulation. watts and zalik, in their contribution, illustrate the quandary encountered by researchers seeking data from the nigerian oil industry where information is 'consistently unreliable'. the nigerian context, and the oil industry internationally, fosters "epistemological vertigo" wherein state agencies and international oil companies often release uneven and contradictory information on oil spills, using incommensurable spatial and regional categories. focusing on oil spill data in nigeria, watts and zalik watts and zalik, draw attention to the inadequate estimation of the cost of pollution borne by residents of the niger delta, and the need to internalize and account for socioecological damages of the extractive regime. the practice of data obfuscation, they argue, is not a minor discrepancy but rather an ingrained and deliberate culture of opacity that is not unique to nigeria (gilbert and zalik, ) . the unreliability of the data provided by state and private oil companies has implications for the reliability of eiti disclosures. this is central to nnimmo bassey 's editorial intervention centering upon ecological damage of the extractive sector as a "blind spot" in oil and gas industry accounting practices. using the example of the neiti audit, bassey notes that the "regurgitation of oil company narratives", and data -including oil spill data, reproduce the erroneous impression that oil spillages are caused in great majority by crude oil thieves, and not by the oil-producing companies that leave pipelines poorly protected and create the context of impoverishment that made crude oil theft (or direct resource control from the perspective of some of its protagonists) one of the few sources of income in the region. bassey centres his analysis on the enormous pollution caused by the oil and gas industry, which in turn reduces local livelihood options. in absorbing the oil and gas industries enormous ecological costs (externalities), local communities subsidize and increase petroleum's contribution to state revenues. thus, bassey emphasizes, the neiti act in nigeria should be broadened to accommodate the overlooked environmental costs of extraction. isaac 'asume' osuoka (osuoka, ) argues that as the eiti spotlighted southern regimes' mismanagement of extractives revenues, the initiative and related discourses mask the complexities of post-colonial state-building. the northern economy driven reforms in the post structural adjustment era institutionalized a private-capital driven rentierism and governance code that validated and normalized corporate self-regulation and depoliticization, with initiatives such as neiti a quintessential example. squaring with omolade adunbi's (adunbi, ) contribution to this section, osuoka argues that the eiti and neiti are a depoliticizing response to s mobilizations for resource sovereignty and civic demands for democracy. such institutionalization of resource struggles over-simplified the claims for broader control and redistribution by centering and delimiting them to transparency discourse. "public participation" in the eiti is informed by a flawed euro-western imagination of a one-way relationship between civil society and the state. osuoka points out that the nigerian 'public' is divided into different spheres including civil society -of which ngos are part, and community, that engage in multilinear and competing relationships with the state. by accommodating the agendas of a few ngos, the eiti has had a limited resonance among other publics. the result is that disclosures from neiti audit processes have not spurred significant public demands for accountability in the extractive sector, despite the integrated role of ngo actors in the eiti process. compared to the neiti audits, mass political action by multiple publics, as reflected in the 'the january uprising' of , offered a more promising although fleeting opportunity for substantive transparency and reform of the oil and gas sector. omolade adunbi adunbi, uses the examples of local ngos active in the neiti processes, particularly civil society legislative action center (cislac) and publish what you pay (pwyp) nigeria, to demonstrate how local actors linked to transnational networks promote the reconfiguration of power and knowledge production to privilege the state and corporations. ultimately the marginality of communities in sites of extraction is reinforced. adunbi examines how a system of extractive practices impact the lives of niger delta inhabitants and entangle them in contestations with corporations and the state over claims for control and benefit from oil resources. however, in focusing on the transparency and accountability of state revenues, neiti ignores the core issues of injustice and redistribution at the local scale, for communities embedded in extractive sites. for adunbi, the transparency campaigns of pwyp and local affiliates shift the focus of civil society discourse away from environmental degradation and loss of livelihoods. using statements by faith nwadishi, a national leader of pwyp nigeria, he supports the view that ngos' power has been reconfigured and built in partnership with the government and corporations that are part of the oil enterprise. through neiti, ngos validate the petroleum industry as an indispensable contributor to state revenue, and for incremental benefits through institutional reforms, rather than examining alternative and more sustainable forms of economic production. institutional reform was already a focus for ghana, a country that had depended on exporting gold and other primary produce for decades, before significant offshore oil discoveries in . neoliberal reforms had weakened the ghanaian state's regulatory powers and incentivized extraction (hilson ) before the country joined the committee of oil-exporting countries. still, ghana was expected to avoid its past mistakes, and those of nigeria, by creating institutions to ensure transparent management of oil revenues, and to maximize development benefits. akonnor and ohemeng examine the implementation of the petroleum revenue management act (prma) and the ghana extractive industrial transparency initiative (gheiti) (akonnor and ohemeng, ) . they argue that while these institutions are necessary to ensure disclosures of royalties paid to the national government, they are insufficient to prevent misuse of revenues, especially for district and community level development. focused on the transactions of the national government, donor-dependent and relatively weak local civil society groups as well as community residents have limited understanding of the processes employed by these institutions. akonnor and ohemeng propose enhanced civil society and community participation in monitoring public expenditures to ensure an improved social accountability regime. while osuoka, and adunbi query the technicalizing of civil society engagement in the transparency regime, faith nwadishi, like akonnor and ohemeng, supports the development of the technical capacity of civil society participants. in a conversation between isaac 'asume' osuoka, faith nwadishi responds to concerns raised about ngos role in the neiti. nwadishi offers insights from her vantage point as an activist, national coordinator of pwyp nigeria and leader of pwyp africa who has represented civil society in the multi-stakeholder working group of neiti and the international board of eiti. she discusses the historical and ongoing forces that have shaped neiti and the eiti, both of which continue to evolve in response to contestations. while acknowledging the role of publish what you pay in birthing the neiti, and the difficult separation, she highlights specific factors that shaped the domestication of the eiti in nigeria. arriving at a time of heightened mobilizations around oil and gas pollution in the niger delta and a political transition in nigeria, some civil society actors saw the eiti as an opportunity to draw concessions from the post-military national government in nigeria. however, the voluntarism of pwyp and eiti informed civil society's more stringent demand in nigeria, where the neiti act made disclosures mandatory. by utilizing and exceeding the initial eiti requirements, neiti has served as a concrete example that influenced the eiti to favor national legislation, as per the example of canada discussed by ciupa and zalik (ciupa and zalik, ) . however, north-south tensions, and disagreements between civil society and corporations play out at the eiti international board, expressed in a slow response to the push for an expansion of the eiti agenda. while the eiti standard makes requirements for environmental and gender reporting, the corporations and northern states that dominate the eiti continue to resist the inclusion of resource extraction's human rights impacts in the eiti agenda. the eiti resistance to including civil society's concerns with human rights violations and environmental degradation, instead favouring paperwork illustrating corporate payments to states, supports the view that the initiative fulfills the basic premises of audit culture; it provides "cognitive comfort" within complex institutions (power ) while obfuscating windfall profits and protecting industrial secrecy. ciupa and zalik (ciupa and zalik, ) argue that canada's extractive sector transparency measures act (estma), forms part of a broader extractive audit culture that reduces financial risk and legitimates industry practices rather than offering possibilities for substantive reform. in the estma case reporting requirements provide social assurance, while estma's mechanisms tie up civil society's ability to hold firms accountable in a review of disclosures. within the broader context of financial uncertainty and volatility characterizing the early twenty-first century, transparency discourse facilitates the broader project of the internationalization of specific capitalist practices, employing ongoing global colonial relations to do so (bratsis ) . ultimately ciupa and zalik demonstrate that substantive transparency in the extractive sector cannot be achieved without fundamentally altering the government of extraction by dismantling corporate privacy protections. collectively, this section's contents shed light on the relationship between international transparency discourse in the extractive sector, including as implemented through specific domestic protocols, and the persistent association between extractive firms and unaccountable government, socioeconomic injustice and ongoing environmental hazards. transparency in practice, primarily framed in terms of a governance 'lack' emanating from southern states (bracking ) and colonized peoples, ultimately sits within the overall regulatory capture of states in the global north -including canada, the us and the uk -by oil and mining industry interests, a capture that deepened with the new millenium's resource boom . contributors demonstrate how transparency practices have been applied to oil and extractive sector 'host states' in the global south, while the rent-seeking practices that transparency discourse seeks to expose are rarely tied to corporate malfeasance in the north. ultimately the section reveals the unequal implementation of the eiti, with northern actors arriving late to the application of transparency reporting in their home states. revisiting nnimmo bassey's intervention herein, the neglect of ecological cost considerations in the eiti regime has weakens southern exporters' and colonized peoples' demands for substantive resource sovereignty or structural transformation of economic relations. in centering the state and social movements as central regulators of inherently globalized industrial activity, the issue thus points to the need to revive popular forces to champion citizen-centered politics and substantive control of corporations. as this goes to press, and structural racism receives long overdue global attention in reaction to murders of black and other people of colour at the hands of state security forces and through the-covidcrisis, the pursuit of corporate -state transparency should be accompanied by the pursuit of corporate/state reparations to the communities and indigenous peoples impoverished through extraction. a final note: in june , as we were working on this special issue, the international board of the extractive industries transparency initiative (eiti) released its modified standards which, for the first time, include a provision for reporting of environmental impacts. however, implementing countries' reporting obligations are limited to providing an overview of legal regimes and practices. * the authors thank the social science and humanities research council of canada (partnership development grant -constructive substantive transparency -) and york university for financial support. the editors are especially grateful to professor gavin hilson for his support toward the completion 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olaseni, abayomi o.; akinsola, olusola s.; agberotimi, samson f.; oguntayo, rotimi title: psychological distress experiences of nigerians during covid- pandemic; the gender difference date: - - journal: social sciences & humanities open doi: . /j.ssaho. . sha: doc_id: cord_uid: r w milu this study examine the psychological distress experience of nigerians during the covid- pandemic, across gender. from march , , to april , , this descriptive survey used a snowballing sampling technique to select -nigerians with an online semi-structured questionnaire detailing the impact of event scale-revised, generalized anxiety disorder – item scale, patient health questionnaire and insomnia severity index. gender had an insignificant difference in the level of insomnia (χ ​= ​ . ; df ​= ​ ; p ​> ​ . ), however, . % of males had sub-threshold of insomnia, . % experienced moderate insomnia and . % had severe insomnia; % females reported sub-threshold of insomnia, . % had moderate insomnia while . % had severe insomnia. also, gender had an insignificant difference in the measures of depression (χ ​= ​ . ; df ​= ​ ; p ​> ​ . ); . % males reported minimal depression, . % had mild depression, . % had moderate depression; . %– . % males had moderate to severe depression while, . % of the females had minimal depression, . % reported mild depression, . % had moderate depression, . %– . % had moderate to severe depressive symptoms. posttraumatic stress symptoms (ptss) has no gender difference among respondents (χ ​= ​ . ; df ​= ​ ; p ​> ​ . ); % of males reported partial ptss, . % presented clinical ptss, and . % males had severe ptss; while . % of females had severe ptss, % reported partial ptss and . % had clinical ptss. respondents reported insignificant gender differences on anxiety (χ ​= ​ . ; df ​= ​ ; p ​> ​ . ), while % reported moderate anxiety and % exhibited severe anxiety during the covid- pandemic in nigeria. findings revealed that nigerians experienced psychological distress during covid- pandemic. the government and stakeholders should initiate tele-mental health services to serve as alternative to traditional treatment to manage present and future pandemic psychological implications among nigerians. a great threat of a novel viruscoronavirus otherwise known as covid- pandemic rocked the entire world in the wake of the year . covid- which was first reported in december in wuhan china, declared as public health emergency of international concern in january and later a pandemic in march by the world health organisation (who) (web news, ; world health organisation, ). the threat is so strenuous that the entire world was placed on lockdown in the matter of social restriction such as on international and national transport links, market or business transaction, school and organisation activities, and all related social and religious gatherings. being a novel disease that is highly contagious, spreading fast across the world, and the fact that there is yet to be an established cure for it, the covid- pandemic has created a lot of panic in every part of the world. also, information and misinformation about such factors as those associated with the transmission of the virus, period of incubation, and impact on the socio-economic, political and psychological livelihood of people in the society put the general population at risk of mental health distress. in nigeria, there is no empirical finding (to the best knowledge of the investigators) establishing the impact of covid- pandemic on the mental health of the general populace. however, several studies especially in asia and europe (bao et al., ; brooks et al., ; kang et al., ; shigemura et al., ) have reported serious psychological distress experiences of members of the society in response to the covid- pandemic. considering its grave impact, the covid- pandemic has been likened to natural disasters , mass dispute, and war outbreaks (fiorillo & gorwood, ) . the present pandemic is, however, more devastating because unlike during a natural disaster or war outbreak whereby people can relocate or build a sophisticated defence system to minimize or escape any foreseeable negative impact, there is nowhere to run to escape the impact of covid- pandemic (olapegba et al., ) . the effect is far-reaching beyond a specific geographical location as the political and socio-economic structure of the whole world is disrupted and crashing, thus putting people more at risk of experiencing psychological distress (raviola et al., ) . it has also been argued that in periods of disease outbreaks, anxiety in the community can rise after the first death of a patient is being reported, also misinformation from media and increasing number of new cases can predispose people to serious psychopathology . kang et al. (kang et al., ) also opined that the present covid- pandemic will drastically increase global stress and mental health burden. according to xiang (xiang et al., ) , the experience of the ongoing covid- pandemic is triggering tension and a timely understanding of mental health is very essential for the government, health agencies and the public. recent studies affirm the high and huge level of psychosocial consequences of outbreaks like covid- on individuals, the general public, and the international community (hall et al., ; wang et al., ) . for instance, in the period of sars outbreak, many that were examined on the psychological consequence showed substantial psychological complications that were found to be related with young people and exacerbated blaming of self (sim et al., ) , while those older people who were females and highly schooled, displayed higher anxiety feelings for sars positivity, while the less educated had a moderate anxiety rate; those with known contact history with the infected individuals, perceived they have symptoms of sars and have more tendency to indulge in preventive measures against the disease (leung, ) . furthermore, the means of containing the pandemic such as; selfisolation, quarantine, social distancing, and treatment of infected persons can further pose a detrimental effect of psychological distress (fiorillo & gorwood, ; world health organisation, ) . specifically, the loneliness effect of reduced social interactions is a risk factor for several psychological disorders such as; anxiety, drug use, insomnia, major depression, and suicidal ideation especially among vulnerable populations like the elderly and those with health challenges. according to rubin et al. (rubin & wessely, ) , excessive quarantine tends to give rise to anxiety significantly, for multiple reasons; even the elevated anxiety may also trigger and initiate the implications for some related mental health issues. barbisch et al. (barbisch et al., ) had earlier pointed out the implication of confinement on the psychological well-being of the public, by identifying hysteria, rejection and dejection feelings, obsessive-compulsive symptoms and mood challenges as conditions that can lead to complicated health issues in the victims and the public. despite the devastating effect that dealing with highly contagious and threatening disease expose healthcare workers to in sub-saharan africa, a concern has been raised that the government in the region has not paid enough attention to the psychological distress implications of a pandemic such as a coronavirus on her healthcare workers (higgins, ) . in nigeria, it has been opined that despite financial aid and infrastructural support being received from both local and international organizations, the government pays little or no attention to the necessary psychological well-being of healthcare professionals on the frontline of combating coronavirus pandemic (guardian, ; web news, ) . concerning the aforementioned, it is noteworthy that seeking to devise a better approach to addressing the imminent and present psychological problems of people who witnessed the covid- outbreak is a necessity. this, therefore, calls for objective assessment of levels and patterns of possible psychological distress among the general population to inform necessary interventions. as at the time of data collection for this study, no study (to the best of knowledge of the investigators) existed that investigated the psychological impact of covid- on the general population in nigeria, therefore this study becomes very relevant. consequently, this study represents the first one examining the psychological impact of covid- among the general population in nigeria. this study aims to establish the prevalence of common psychological distress among the general public, and identify the specific pattern of occurring psychopathology among nigerians during the pandemic. to address the aim of this study, the following objectives were raised: . to examine the prevalence of insomnia outcomes among residents of nigeria among residents in nigeria during the covid- pandemic. . to investigate the prevalence of depression symptoms across categories of male and female residents in nigeria during the covid- pandemic. . to assess the prevalence of posttraumatic stress symptoms across male and female residents in nigeria during the covid- pandemic. nigeria during the covid- pandemic. this study utilised a cross-sectional descriptive survey research design that entailed collecting quantitative data on more than one case at a single point in time or simultaneously in survey research. the main variables of interest are depression, generalized anxiety, insomnia, and posttraumatic stress. this design was found applicable to describe the psychological distress experiences of nigerians during the covid- pandemic. a snowballing sampling technique was used in this study because data collection was conducted during a nationwide lockdown in response to the covid- pandemic which made it very difficult to physically access people at the time of data collection. an online semi-structured questionnaire was developed by using google forms, with a consent form appended to it. the link of the questionnaire was sent through emails, whatsapp, and other social media to people on the contact of the investigators. the prospective respondents were then encouraged to roll out the survey to as many of their colleagues as possible. thus, the link was forwarded to people apart from the first point of contact and so on. five hundred and two ( ) nigerians aged between years and years (m ¼ . , sd ¼ . ) participated in the study. the participants comprised ( . %) males, ( . %) females, while ( . %) did not disclose their sex. in terms of ethnic affiliations, the majority of the participants ( . %) identified with ethnic groups in the southern region of nigeria, while . % indicated they were from ethnic groups in northern nigeria, the remaining . % did not disclose any specific nigerian ethnic affiliation. in terms of religious affiliation, the majority ( . %) are christians, . % are muslims, while only . % practiced other religions, and . % of the respondents identified themselves with traditional religion. data on the marital status of participants showed that . % were married, . % unmarried, and . % were separated. finally, categorization based on the highest level of education, only . % of the participants had secondary school education, . % reported incomplete tertiary education, . % completed tertiary education, and the remaining . % had postgraduate education. data were collected via an online self-reported questionnaire designed by the investigators. the questionnaire contained five sections. the first section consisted of information assessing demographic attributes such as sex, age, religion, and marital status of participants. the second section contained the -item impact of event scale-revised (ies-r). the scale was developed to measure the subjective response to a specific traumatic event, especially in the response sets of intrusion, avoidance, and hyperarousal, as well as total subjective stress ies-r score. the ies-r is not meant to be diagnostic. the total ies-r score was divided into - (normal), - (mild psychological impact), - (moderate psychological impact), and > (severe psychological impact). weiss (weiss et al., ) affirmed the validity and reliability of the scale. cronbach's alpha . was established as the reliability coefficient for the scale in this study. in section three of the questionnaire is the generalized anxiety disorder -item (gad- ) scale (spitzer et al., ) consisting of questions assessing generalized anxiety disorder, focusing on the frequency of symptoms during the preceding -week period. the gad- requires approximately - min to administer and for each symptom queried provides the following response options: "not at all," "several days," "over half the days" and "nearly every day" and these are scored, respectively, as , , or . a score ranging from to is obtainable by respondents. scores of , , and are taken as the cut-off points for mild, moderate and severe anxiety, respectively. cronbach's alpha . was established as the reliability coefficient for the scale in this study. the fourth section contained the patient health questionnaire (phq- ). the phq- is a nine-item depression scale that has the potential of being a dual-purpose instrument to establish the diagnosis of a depressive disorder, as well as the grade of symptom severity (kroenke et al., ) . statements measuring depressive symptoms such as "little interest/pleasure in doing things" were rated from (not at all) to (nearly every day) by respondents as applicable to them over the past two weeks. phq- score can range from to . the scale has strong psychometric properties and has been widely used. cronbach's alpha . was established as the reliability coefficient for the scale in this study. the fifth section contained the insomnia severity index, a -item selfreport questionnaire assessing the nature, severity, and impact of insomnia. participants were required to rate their sleep condition in the last weeks as described by each item of the scale. questions on the isi cut across the severity of sleep onset, sleep maintenance, and early morning awakening problems, sleep dissatisfaction, interference of sleep difficulties with daytime functioning, noticeability of sleep problems by others, and distress caused by the sleep difficulties. the scale is responded to on a -point likert scale with a score ranging from to ; thus, yielding a total score ranging from to . the total score is interpreted as follows: the absence of insomnia ( - ); sub-threshold insomnia ( - ); moderate insomnia ( - ); and severe insomnia ( - ). previous studies have reported adequate psychometric properties for both the english and french versions (bastien et al., ) . cronbach's alpha . was established as the reliability coefficient for the scale in this study. this was an online study. participants with access to the internet were invited to participate in the study. participants with age more than years, able to understand english and willing to give informed consent were included. a link to the survey on google form was sent to all participants. on receiving and clicking the link, the participants got auto directed to the information about the study. a detailed informed consent form was attached at the beginning of the online questionnaire and consent was a prerequisite to continue in the survey. therefore, only individuals who gave their consent participated in the study. the data collection was initiated on march , and closed on april , . the sampling technique employed allowed the investigators to collect data from across various states of nigeria. five hundred and two ( ) correctly filled questionnaires were recovered through the google form and processed for statistical analysis. the collected data was analyzed using the spss package (version ) and graphpad prism (v . . ). the analyzed data respond to the four research questions stated in the early paragraph. the analyses include prevalence estimate analysis, and chi-square analysis was therefore presented. this phase presents the results and interpretation of data collected on the prevalence of psychological distress among five hundred and two ( ) residents in nigeria during the outbreak of the pandemic. the prevalent rate of psychological distress outcomes was reported among residents of nigeria across the six geopolitical zones. based on the exploratory process, outcomes of the evaluated psychological constructs were presented in the chart below (see charts - ). chi-square contingency chart (see chart ) revealed that there was no significant difference in the reported severity of insomnia among female and male residents in nigeria during pandemic (χ ¼ . ; df ¼ ; p > . ). however, prevalence estimates analysis revealed that majority of the male respondents ( . %) had no clinical insomnia, . % of the male participants reported sub-threshold level of insomnia, . % of the respondents had moderate insomnia symptoms, while . % of the male respondents presented severe clinical insomnia during the covid- pandemic. it was further reported that majority of the female respondents ( %) had no clinical insomnia symptoms, % reported subthreshold level of insomnia, . % had moderate insomnia symptoms, while . % of the female respondents presented severe clinical insomnia during the covid- pandemic. further analysis that aimed to reveal the prevalence of depression symptoms across categories of male and female residents in nigeria was tested using a contingency analysis of the graphpad prism (see chart ). chi-square contingency chart (see chart ) revealed that there was no significant difference in the reported severity of depressive symptoms among female and male residents in nigeria during pandemic (χ ¼ . ; df ¼ ; p > . ). however, prevalence estimates analysis revealed that majority of the male respondents ( . %) had minimal depressive symptoms, . % reported mild depressive symptoms, . % of the respondents had moderate depressive symptoms, . % had moderately severe depressive symptoms, while . % of the male respondents presented severe depressive symptoms during the covid- pandemic. it was further reported that majority of the female respondents ( . %) had minimal depressive symptoms, . % reported mild depressive symptoms, . % had moderate depressive symptoms, . % had moderately severe depressive symptoms, while . % of the female respondents presented severe depressive symptoms during the covid- pandemic. based on the study objectives, the analysis that aimed to reveal the prevalence of posttraumatic stress symptoms across male and female residents in nigeria was tested using a contingency analysis of the graphpad prism (see chart ). chi-square contingency chart (see chart ) revealed that there was no significant difference in the reported severity of posttraumatic stress symptoms (ptss) among female and male residents in nigeria during pandemic (χ ¼ . ; df ¼ ; p > . ). however, prevalence estimates analysis revealed that the majority of the male respondents ( . %) had no pts symptoms, % reported partial pts symptoms, . % presented clinical pts symptoms, while . % of the male respondents presented severe pts symptoms during the covid- pandemic in nigeria. it was further reported that the majority of the female respondents ( . %) had severe pts symptoms, % reported partial pts symptoms, . % had clinical pts symptoms, while % of the female respondents presented no pts symptoms during the covid- pandemic. further objective to explore the prevalence of anxiety symptoms among residents in nigeria during covid- pandemics was tested using prevalence estimate analysis of the graphpad prism (see chart ). chart revealed that there was no significant difference in the disparity of anxiety symptoms among residents of nigeria during the covid- pandemic (χ ¼ . ; df ¼ ; p > . ). based on chart , it was revealed that the majority of the residents in nigeria insignificantly had moderate anxiety symptoms during the covid- pandemic. in other words, % of the participants in the study had moderate anxiety symptoms (i.e. incapacitating level of anxiety), while approximately % of the residents exhibited severe anxiety symptoms in nigeria. the outbreak of deadly disease is not a new occurrence in nigeria; the country has faced so many outbreaks of emerging and reoccurring diseases such as malaria, avian influenza, ebola virus, hiv/aids, meningitis, lassa fever, tuberculosis, monkeypox and many more (nigeria centre for disease control, ) and yet, it thrived above all these outbreaks. for a country that has no recent serious prior experience with natural disasters such as tsunami and earthquake (hansen, ) , and infectious disease such as sars, the country and its occupants seem overwhelmed with the covid- pandemic. the novel covid- pandemic has brought along with it, innovation and changes that nigerians are not used to which can lead to psychological distress. nigerians are distinct people with a rich social culture such as; partying, hanging out and routine dropping off and picking up of children at school, termed "school runs", is a social activity and opportunity of networking for most parents. therefore, the lockdown, physical and social distancing, closure of schools and the imposition of the use of face/nose mask could serve as stressors among this population. also, amidst the fear and risk of contagion of the covid- , the changes in the day to day activities of so many nigerians would have caused the prevailing psychological distresses. the overall prevalence of insomnia indicated was % among the general public in nigeria ( . % severe insomnia and . % moderate insomnia), a little less than a quarter ( %) indicated experience of moderate depression to severe depression and a quarter ( %) of the population indicated experiencing symptoms of severe posttraumatic stress and . % indicated experiencing symptoms of clinical posttraumatic stress. on april , , the nigeria centre for disease control reported that nigeria has recorded confirmed cases of covid- and deaths in states and the federal capital territory (nigeria centre for disease control, ), this figure seems quite low in comparison to the figures reported in china and the global recorded death. the low reported confirmed cases (as at the time of data collection) may have culminated in the lower prevalence of depression reported (moderate depression . %, moderately severe depression . % and severe depression . %) among nigerians as against higher reported prevalence of depression due to covid- pandemic among chinese citizens (gao et al., ) . the researchers reported the prevalence of depression among general chinese citizens has . % and reported prevalence of depression among hospitalized patients in wuhan, china has . % (gao et al., ) . confirming the output of our study, clinical psychological scientists at the university of washington have requested the need to prepare for a possible clinical depression epidemic because of covid- (the conversation, ) . consistent with our study findings of the prevalence of psychological distress among the public in nigeria, wang, et al. (wang et al., ) reported prevalence of moderate or severe psychological impact of the covid- outbreak among the public in china and bo et al. (bo et al., ) reported that before discharge, most clinical stable covid- patients suffered from significant posttraumatic stress symptoms. importantly, the prevalence of posttraumatic stress symptoms during covid- was lower among chinese citizens; sun et al. reported . % posttraumatic stress symptoms and % in china hardest-hit areas (liu et al., ) , while the public in nigeria reported higher experience of posttraumatic stress symptoms ( %). the difference in prevalence between the two populations can be attributed to the direct experience of the covid- devastation by the chinese population at the early stage of the outbreak and the nigerian population observation of the event through mass media. the several misleading information on the social media relating to the covid- from its inception and the increase in confirmed cases in nigeria could have heightened the experience of posttraumatic stress symptoms of the nigerian population. adult females and even children (female) provide unpaid care in families (sandoiu, ) in nigeria, which ranges from cooking, washing, taking care of kids, and general cleaning of the house. due to the lockdown, stay at home mandate of the federal government and cleaning of surfaces mantra, most female household chores have been doubled or tripled in most cases and this can be distressing. there has been an upsurge in the issues of domestic violence against women and the girl child, which prompted amina mohammed (un deputy secretary-general) to call on all governments, civil society, and individuals to consider gender-based violence as a dominant issue of all domestic plans on covid- response (united nations, ). so many women in nigeria, especially those in abusive marriages and relationships have no escape because of the restriction of movements and lockdown in most states of the country (daniels, ) . against this backdrop, it was expected that females should indicate the higher experience of psychological distress but our study found no substantial variation between male and females' experiences on psychological distresses during covid- pandemic, though articles and studies have contrary opinions. women in eight countries across africa (nigeria not included) and asia were reported to have consistently self-reported higher sleep problems than men based on series of roles they play in families (stranges et al., ) , female more than their male counterpart were confirmed to be susceptible to insomnia (zhang & wing, ) and high posttraumatic stress symptoms (liu et al., ) . similar to our findings of % experience of insomnia (moderate to severe), a korean population reported an overall prevalence of insomnia symptoms of . % which included difficulty in initiating sleep, difficulty in maintaining sleep and early morning awakening but the symptoms were more prevalent in female than in male (la et al., ) . the similarity of the genders on their psychological distress during the covid- based on the peculiarity of the population can be attributed to a deep culture that has made women in nigeria believe that it is socially acceptable to be hit and discipline (standard, ; trust, ) , hence, they might have adapted to the situation at a significant level that it does not cause them psychological distress. in conclusion, our findings expose the prevalence of insomnia, depression and posttraumatic stress symptoms among nigerians during the covid- pandemic. though this study recorded no significant difference between the gender (male and female) experiences of insomnia, depression, posttraumatic stress symptoms and anxiety, the study result reported a relevant prevalence of outcomes of psychological distress among the general public in nigeria. the government of nigeria should make available, if not for all, psychological health services for survivors of covid- . the study does not involve larger numbers of nigerians to ascertain the generalizability of the current findings. it is also possible that outcomes would vary if measured over a thousand or more participants. some socioeconomic factors should have been included in this study to ascertain the comorbid factors that could aggravate psychological distress in the current pandemic among nigerians. finally, the issue of response bias, which is prevalent in self-report surveys could have influenced the result and considered a limitation to this study. considering the findings of this study, the following are suggested to enhance psychological wellbeing among nigerians during the pandemic period: . tele-psychotherapy means of managing psychological distress among the public should be adopted by stakeholders during a lockdown and infectious disease outbreak like this. this intervention has been found to be effective in treating disorders such as; anxiety, depression, suicide attempts, trauma-related problems, insomnia, etc in the face of a pandemic that strains health care resources (augenstein, ; national quality forum, ) . especially when face-to-face appointments are risky. . federal and state governments should initiate a bill honoring the telemental health services to manage present and future pandemic psychological implications. . healthcare stakeholders needed to collaborate with psychotherapists in the management of pandemic or disease outbreak to regulate residents' emotions and promote people's psychological wellbeing in society. . experts should start an awareness campaign on basic means of overcoming psychological distress on media and in communities generally in nigeria to foster mental healthiness. opportunities to expand telehealth use amid the coronavirus pandemic -ncov epidemic: address mental health care to empower society is there a case for quarantine? perspectives from sars to ebola. disaster medicine and public health preparedness validation of the insomnia severity index as an outcome measure for insomnia research posttraumatic stress symptoms and attitude toward crisis mental health 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study among more than , older adults from countries across africa and asia prevalence and risk factors of acute posttraumatic stress symptoms during the covid- outbreak in wuhan covid- could lead to an epidemic of clinical depression, and the health care system isn't ready for that cultural beliefs fuel domestic violence. archived from the original on september un backs global action to end violence against women and girls amid covid- crisis immediate psychological responses and associated factors during the initial stage of the coronavirus disease (covid- ) epidemic among the general population in china psychologist advocates increased palliatives to cushion lockdown effect the impact of event scale: revised advice and guidance from who on covid- timely mental health care for the novel coronavirus outbreak is urgently needed sex differences in insomnia: a meta-analysis supplementary data to this article can be found online at https:// doi.org/ . /j.ssaho. . . key: cord- - e hhia authors: olapoju, olabisi michael title: estimating transportation role in pandemic diffusion in nigeria: a consideration of - influenza and covid- pandemics date: - - journal: journal of global health doi: . /jogh. . sha: doc_id: cord_uid: e hhia background: the focus of the study is to assess the role of different transport means in the importation and diffusion of - influenza and a novel corona virus designated as covid- in nigeria. methods: the study provides a review of the means by which the two pandemics were imported into the country and the roles the transport means of each period played in the local spread of the epidemics. results: the study notes that seaports and railways, being the emerging transportation modes in the country were significant to the importation and local diffusion of - influenza, respectively, while air transport is significant to the importation of the current covid- pandemic. conclusions: the study concludes that increasing preference for the transport at a given epoch is significant to the diffusion of prevailing epidemic in the epoch. for most of human history, population have been largely relatively dispersed both at regional and continental scales. however, recent centuries have witnessed an extensive human contact as a result of development in means of transportation, accompanying trade expansion, population boom and city expansion. while development in transport technology till date continues to enhance peoples' socio-economic and political existence, movement of disease has also been associated with increasing human movement through development in transportation network. specifically, records of disease diffusion in the last years had provided numerous examples of how the establishment and expansion of worldwide transport networks has facilitated global pandemics of communicable diseases. for instance, the black death of th century revealed accounts of transmission and eventual death that was consistent with the arrival of travellers in sicily in [ ] and whose further transmission was halted by limiting transportation and movement patterns. there was the cholera outbreak in india which later became global pandemic as it spread across many countries of the world along trade routes reflecting the expanding reach of the global transport system and increased movement of people [ ] . the influenza pandemic of - presented one of the world' s most devastating short-term demographic disasters, killing an estimated million people in about months globally [ , ] . the speed of transmission of this infectious disease was greatly influenced by growing transport network in the world. viewpoints research theme : exactly one century away, at the end of , an infectious disease known as coronavirus named as sars-cov- ) by international committee on taxonomy of viruses (ictv) and now tagged covid- (arising from the family of the virus and the year of emergence) broke out in wuhan, china. since discovery, and as at the time of writing, covid- has spread to over countries and territories with a total case of confirmed cases and deaths globally. high transmission efficiency of covid- is attributed to convenience of global travel. the objective of this study is to provide an assessment of the nature and role of transport in the importation, traffic and spread of - influenza and covid- in nigeria. this is with a view to examining changing significance associated with prevailing transportation at the period of epidemics. the study reviews historical data of - influenza in nigeria as well as report of cases of current pandemic known as covid- in the country. next sections provide review of the - influenza in nigeria, situation of covid- in nigeria, comparative narration of the nature and role of transport in diffusion of - influenza and covid- in nigeria, discussion of the comparative review and conclusion. the influenza pandemic of - was one of the most pervasive and devastating biological disasters ever recorded in the world. though there were contentions on the origins of - influenza pandemic, its spread however, was typical of that of human travel, as it traveled from place to place. major diffusion began in europe to the rest of the world. africa recorded its first hit from a ship that had docked in a british port from where it carried persons infected by influenza to freetown, sierra leone in august [ ] . in a similar vein, an american vessel s.s. shonga, which made a brief stop in freetown carried influenza victims in freetown to cape coast. the ship which anchored for a few days in cape coast continued its journey to accra with virtually all its crew down with influenza. however, by september , , the influenza hit lagos through lagos seaports by an ocean liner, s.s. bida which carried already infected passengers from accra, gold coast, who, on arrival in lagos passed the disease to lagos residents. inhabitants around the seaports of marina and apapa, especially seamen working on ships docked on harbour ports were one of the first sets of people to be infected with this virus. the epidemic spread quickly into the hinterland especially lagos mainland and then followed trade routes, such as railway lines, motor roads, rivers and caravan routes. the progress of spread of the epidemic was based on the speed of normal transport prevailing on each highway [ ] . but since the train was the major means of local transportation back then, locations such as abeokuta, ibadan, illorin, bida, jebba, zaria, kano, and bauchi which were linked to the existing rail lines were quickly affected by the epidemic [ ] . while populations along the western railway continued to be stricken by this disease, passenger vessels continued to bring infected people into other coastal towns of nigeria. for instance, by september, another vessel called s.s. batanga had arrived calabar port with a man suspected to be a victim of influenza. also, forcados was not spared as ocean liner s.s. ravenston brought crew and passengers already infected by the disease to forcados on september. other ports affected included burutu, warri, port-harcourt and bonny with this epidemic penetrating various residential districts and neighbouring towns by roads. by december , it had spread all over the country right from the first outbreak in lagos. by the end of , an infectious disease known as coronavirus named as sars-cov- ) by international committee on taxonomy of viruses (ictv) and now tagged covid- (arising from the family of the virus and the year of emergence) broke out in wuhan, china. by january , , who (world health organization) declared covid- epidemic as a public health emergency of global concern [ ] . according to who report on th march, , there are confirmed cases of covid- , confirmed deaths across countries of the world. as at the time of writing this manuscript, there was a global record of cases of infection and over deaths across over countries and territories of the world [ ] . though intermediate source of origin of this disease as well as clinically approved drug or vaccine have not been determined, there is a clear evidence that it assumes high human-to-human (hence, h h) transmission mode. in addition, international travelling was adjudged to have heightened the importation risk of this virus especially from the affected locations in china thus making most countries vulnerable to the epidemic. more vulnerable is african continent because china at present is africa' s leading commercial partner as large travel volumes through which the epidemic could reach the continent already exist. however, africa recorded its first case in egypt on february , through viewpoints research theme : covid- pandemic travellers returning from hotspots in asia, europe and the united states [ ] . since then, more than countries have reported cases, initially, mainly confined to capital cities, and now spreading to a multiple provinces. historical data has provided evidence of the role of transport, cross-border movement and regional flow of humans as veritable means of disease importation and spread. assessment of - influenza and covid- revealed that water transport (ocean and inland waterways) and air transport played significant gateway roles in the importation of the two pandemics. whereas, railway and road ways played significant role in lateral spread of both pandemics, respectively. the evolution and growth of nigeria' s seaports belong to contrasting historical periods -the pre-modern and modern periods [ ] . these periods were made up of some phases of alternating port concentration or spatial consolidation and port diffusion or dispersed port development in nigeria. the interest of this study is the period of port development that coincided with the outbreak of - influenza in nigeria. this period was between - , the fifth stage of development and a period of port concentration. at this period, lagos, akassa, old calabar, sapele, warri and degema ports had become the dominant ports in the hierarchy of all the ports in nigerian space economy. specifically, in , lagos port had become more dominant handling about % of the total port traffic in the country, while burutu and calabar ports were handling % and % of total traffic respectively. the significance of this was seen in the diffusion of - influenza through these ports. it is noteworthy that concentration of nigerian trade in lagos ports, burutu, calabar, warri, port-harcourt and bonny ports were responsible for the penetration of the epidemics into the country. however, with the import of the epidemic into the national territory, local transmission took its turn with rail, road and inland water transports playing significant roles in the diffusion of the epidemic locally. viewpoints research theme : the significance of rail transport in internal spread of - influenza in nigeria was apparent because it coincided with the periods when network of railways were being constructed across the country between and [ ] primarily to facilitate economic exploitation and administrative control of their regions. the raging of the influenza along the railway lines was such as if railway network was planned in preparation for the epidemic. railway influence on local transmission of the epidemic was underscored by the report of the occurrence of the epidemic in virtually all northern towns and villages, commencing with settlements along ilorin-kano railway, with kano becoming primary point of diffusion in northern part of nigeria. the influenza moved southward along the course of niger river. by october , the epidemic was brought to onitsha through lokoja and later spread to entire towns and villages [ ] . the spread continued eastward to reach owerri, okigwe and enugu-ngwo and many other towns along the eastern railway. the influence of rail transport was also significant in the spread of the epidemic to benin kingdom, though this region was also adjudged to be bedeviled from coastal area of forcados, warri and sapele. however, with severe damage that was done to transport infrastructure during the civil war coupled with the post reconstruction and building preference given to road ways over railways, as well as perennial operational and organizational challenges, preference for rail transport has reduced to its abysmal minimum and major traffic greatly reduced. since then, nigeria railway remains static in structure and highly dormant to emerging transport dynamics across the globe in the last to decades, especially considering modernization, and advancement in railway infrastructure and equipment which have enabled railway fulfill its role efficiently and effectively. though recently, governments have mustered some efforts at revamping the railway system in some parts of the country, its present state may account for its non-significance to local transmission of recent epidemic in the country. on the contrary, air transport plays the most significant role in the importation of covid- in nigeria as is the case with virtually all the countries that are affected by the epidemic. the significance of air transport in today' s global endeavours is imprinted in most socio-economic calculations, political negotiations and environmental considerations in all of the world' s deliberations. this is reflective of barnes' prediction of air transport becoming a vital component of the economies of major cities, as it provides fast personal access for business, social, or recreational purposes, as well as fast physical access to resources and markets [ ] . it is informing to note that air transport is yesterday' s future transport. the role played in the diffusion of covid- is unavoidably significant, especially considering the humongous passenger traffic it handles in recent times. according to airports council international (aci), global airports handled . billion passengers in [ ] and this is expected to be more than double, exceeding billion by [ ] . over the past few decades, air transport networks have developed and internationalized though very unevenly, overall technological development, internationalization of economic development, increasing purchasing power, increasing tourism activities among other issues have led to sharp rise in air connections both at regional and international scales. it is thus significant to note that attendant asymbiotic relationship exists between global ease of travel provided by air transport and the spread of epidemic and disease. the ease with which inter-regional and inter-continental travel is been achieved in the recent period is sine qua non to the ease of importation of covid- . the role of transportation in the diffusion of epidemics has not been unnoticed at different times of outbreak of epidemics. this study assessed the significance of mode of human transportation to importation and local diffusion of two epidemics which occurred century apart- - influenza and current covid- epidemics. the study observed that though both epidemics have not their origin in nigeria, the first case recorded for each of the pandemic were both imported into the country through lagos state which provides a veritable gateway to nigerian economy. however, while the - influenza came through seaport, covid- came through airport. both presenting major international assess to the country. each pandemic reflects the expanding reach and efficiency of the global transport system and increased movements of people [ ] . for instance, the significance of seaports in the importation of - influenza was based on the development of seaports in the country which provided the only option for international movement as pioneer commercial air transport which was to provide a new way of moving goods and passengers around the earth did not start until s-a period after the epidemic. whereas, the efficiency, speed and reach of air transport networks was responsible for the importation of covid- , a completely new disease. this is supporting the view of ever-expanding air transport network as significant to the extent and speed of spread of disease [ ] [ ] [ ] . thus, the prominence gained by air transport in the importation of covid- above seaports as an alternative gateway to nigerian economy suggests that the transport of the future has significant role to play in the diffusion of the disease of the future. fevers in the tropics nature's biological weapon updating the accounts: global mortality of the - "spanish" influenza pandemic public record office. the influenza epidemic of - in the southern provinces of nigeria report of ag. senior sanitary officer novel coronavirus (covid- ) situation report- patterns and problems of seaport evolution in nigeria the tools of empire: technology and european imperialism in nineteenth century the economic role of air transportation aci world airport traffic report, press release aci global traffic forecast severe acute respiratory syndrome (sars): a year in review spread of a novel influenza a (h n ) virus via global airline transportation severe respiratory syndromes: travel history matters though, the study highlighted the role of railway in the intra-national diffusion of - influenza, it is not certain it has any role in local spread of covid- . this may be due to very low traffic patronizing rail transport because of its dormancy for a very long time until recent time when attention is being paid to its resuscitation. it may also be due to the suspension of rail transport activities by nigerian railway corporation (nrc) (independent news online, the st march ) as a way of checking the spread of covid- . - influenza and covid- happened a century apart with both having debilitating impact on human health with attendant death records. the significance of transportation in the importation and local transmission of the two epidemics were obvious. it was evident that the efficiency of spread of each epidemic was determined by the origin of the epidemic and efficiency of the prevailing transport means. it thus means that future transport may have significant influence on the efficiency with which likely future epidemic or disease will be diffused.the limitation of this study is that while one of the epidemics considered had happened about a century ago, the other epidemic is still very much around and fresh with us. thus, current figures on the confirmed cases, death and discharge cases will be needed for further study. also similar study may be carried out to look into a comparative study of the distinctive role of existing transport means in the importation and diffusion of epidemics in sub-saharan african countries as a whole. acknowledgement: i want to acknowledge national centre for disease control (ncdc), nigeria, for regular update of covid- cases.funding: this research work received no funding from any agency or organization.authorship contributions: i certify that this paper was solely written by me. no co-author(s). the author completed the icmje unified competing interest form (available upon request from the corresponding author), and declares no conflicts of interest. key: cord- -g sis authors: meseko, clement; shittu, ismaila; adedeji, adeyinka title: the bush meat trade thrives in nigeria despite anxiety over coronavirus date: - - journal: trans r soc trop med hyg doi: . /trstmh/traa sha: doc_id: cord_uid: g sis nan health concern. the expedition led the team to a bush meat market in a megacity lagos in the southwest of the country on the same day that chinese scientists hypothesized that coronavirus may have been transmitted through pangolins, which are peculiar, slow, harmless ant-eating mammals that are highly sought after for their meat (as a delicacy) and their scales (for use in traditional medicine). although the capture of and trade in pangolins has been banned worldwide because they are an endangered species, the animal is still smuggled from asian and african countries. generally in africa, and in nigeria in particular, pangolins are traded alongside other species like crocodiles at active bush meat markets ( figures a and b) . previously, the same team visited another bush meat market in oil-rich south nigeria, where a rich diversity of killed wildlife were on display ( figures c and d) . it has been claimed that coronavirus may have been transmitted to humans through a probable pangolin intermediate host of the virus that is known to be found in bats reservoir, premised on a report from chinese researchers, who found a coronavirus in smuggled pangolins which had a % genetic match with the virus currently circulating around the world. however, this similarity is not applicable to the entire genome, but relates only to a specific site, which is known as the receptorbinding domain. a few years ago, the ebola virus was initially transmitted to a toddler in west africa and > lives were lost in < y. bats are a known natural reservoir of many pathogens including coronaviruses, ebola, marburg, hendra, nipah and lyssavirus, and researchers have found coronaviruses in nigerian bats. these flying foxes are abundant in wildlife parks and zoos and are also intimately associated with humans in city centre streets and homes. the many pathogens they harbour are not well understood and will necessitate vigilance and monitoring through surveillance and risk analysis. the first case of a coronavirus virus detected in nigeria was 'imported' from italy, in the same manner in which a liberian diplomat 'imported' the ebola virus, ironically through the same international airport in lagos. just as with ebola, we failed to stop the virus at the border. the italian visitor to nigeria graciously checked himself into a hospital when he became ill. c. meseko et al. the case was missed, probably because he was not exhibiting clinical signs, just like the first case of coronavirus in egypt. this phenomenon, now associated with sars-cov- , has further increased the risk of expanded contact exposure to coronavirus and has heightened anxiety, not only in nigeria's megacities, but also across the country. many citizens in nigeria were already wearing surgical masks and observing social distancing, even before there was any scientific evidence of community transmission. meanwhile, diverse wildlife are hunted and brought for sale to the thriving bush meat markets of southern nigeria. the species we observed included antelopes, grass cutters, porcupines, crocodiles, turtles and pangolins. interestingly, many of these animals were displayed alive (some were juveniles) and the market can be described as a live animal (wildlife) market ( figures a and b) . the lesson from the field includes the pos-sibility of interspecies intermingling and sharing pathogens, akin to current observations regarding the emergence of sars-cov- in wuhan, china. also, in real time we observed the exploitation of wildlife resources that may contribute to the extinction of endangered species such as the pangolin. in the midst of upheaval, especially in nigeria, bureaucrats and politicians may miss the fact at the heart of this matter, which is that sars-cov- would have remained innocuous in animals if conditions had not favoured its transmission to humans. it may be in china today, and if care is not taken then it could become an african problem tomorrow, whenever and wherever the conditions are similarly favourable. the lesson here is that policymakers should not lose sight of the root cause of the coronavirus virus outbreak. one health initiative, to proactively identify the animal sources of coronaviruses and similar pathogens, is important for the prevention of new outbreaks. sustainable measures for the control transactions of the royal society of tropical medicine and hygiene of zoonoses and safeguarding public health are more imperative now than ever before. global trends in emerging infectious diseases authors' contributions: cm, is and aa contributed to the study design, study implementation and writing of the paper. cm, is and aa read and approved the final version. cm is the guarantor of the paper. competing interests: none declared.ethical approval: not required. key: cord- -jox yg authors: tijjani, salman jidda; ma, le title: is nigeria prepared and ready to respond to the covid- pandemic in its conflict-affected northeastern states? date: - - journal: int j equity health doi: . /s - - - sha: doc_id: cord_uid: jox yg northeastern nigeria has over the decade suffered from the boko haram insurgency and is still in the process of recovery from the complex humanitarian crisis that has displaced and subjected millions of vulnerable children, women and elderly population to poverty, disease outbreaks, hunger and malnutrition. yet, the conflict-affected states in northeastern nigeria is not far away from being the worse-hit by the covid- pandemic if urgent public health preventive measures are not taken to contain the spread of the deadly and highly infectious virus. the question arises, “what is nigeria doing to tackle the burden of a covid- spread and an ongoing humanitarian crisis? soon after coronavirus disease- (covid- ) was first reported in an italian citizen that arrived nigeria on february , , by the nigerian center for disease control on the th january [ ] , the national emergency operation centers were immediately activated to level to trace and test all his contacts, and the presidential task force on covid- was inaugurated weeks later [ , ] . the number of new cases from community transmissions of covid- has been increasing steadily since the index case was first reported [ , ] . as of nd of april, the total confirmed cases of covid- within nigeria had risen to , with ( %) deaths, ( %) discharges, and ( %) cases currently receiving supportive care [ ] . till this date, the total cases reported in the affected states are: lagos ( ), federal capital territory ( ), osun ( ) , oyo ( ), akwa ibom ( ), edo ( ), kaduna ( ), ogun ( ), bauchi ( ), enugu ( ), ekiti ( ), benue ( ), and rivers ( ) [ ] . of the confirmed cases, ( %) have travel history to high risk countries, ( %) are contacts of known confirmed cases, and ( %) cases have inconsistent epidemiological information [ ] . although the case fatality rate is very low as at nd of april [ ] , there are public health concerns that the community transmissions of covid- in nigeria may exponentially rise in the coming weeks, and wreak havoc to nearly seven million people in dare need of humanitarian assistance across the conflict-affected northeastern part of nigeria [ ] [ ] [ ] , which has since seen its first case of covid- reported in bauchi state on the th of march, [ ] . as people continue to travel freely within, and between the northeastern states, it is only a matter of time before covid- spreads to the rest of the conflictaffected states of northeastern nigeria (borno, yobe, gombe, adamawa, and taraba states) [ , ] . priority highrisk areas to look out for a likely covid- massive spread includes; borno, adamawa, and yobe states, due to lack of laboratory centers for testing covid- in those areas, internally displaced persons (idps) presence, food insecurity, limited public health, and primary care services amidst other complex humanitarian challenges [ , , ] . two factors are the likely reasons to contribute to the anticipated spread of covid- in northeastern nigeria. first, it is probable that the concentrated populations of idps (in camps, camp-like settings and host communities) experiencing humanitarian crises are at high risk of contracting covid- due to; influx of new arrivals of displaced populations from neighboring villages, and towns affected with covid- , frequent displacements due to the boko haram insurgency, high density population in urban centers, lack of essential needs (such as food, water, shelter, health, livelihoods, and non-food items), overcrowding, poor housing, lack of access to potable water, insufficient sanitation and hygiene facilities, traditional beliefs and practices, and inadequate awareness of public health preventive measures [ , , , ] . more so, practicing social distancing, quarantine, isolation, infection, prevention, and control measures are difficult to perform in complex humanitarian settings with pre-existing structural challenges such as the overwhelming concentrations in idps camps, and camp-like settings seen in host communities [ , , ] . similarly, imposing a complete lock down to the pre-existing movement restrictions in some areas of the conflictaffected states of the northeastern region will compound the existing humanitarian needs, and operational challenges facing the affected areas [ , ] . the second factor which is anticipated to make covid- response very challenging in this vulnerable population is the high prevalence of poverty, double burden of endemic infectious, and noncommunicable diseases [ ] which has been on the increase since the emergence of the boko haram insurgency that has devastated the northeastern part of nigeria [ ] . dubbed by the world bank as the poverty capital of the world, and africa's most populous nation [ ] , nigeria, its northeastern region in particular, has experienced the highest prevalence of poverty, malnutrition, anemia, malaria, and has repeatedly over the past decade seen the emergence, and reemergence of endemic diseases such as; cholera, measles, lassa fever, meningitis, hiv and tb [ ] . it is therefore expected that the humanitarian situation in this region will worsen particularly due to covid- [ ] , the double burden of diseases, and conflict overstretching the primary healthcare facilities [ ] , which underlines an urgent need for rapid action in order to meet the current projections of people in dare need of humanitarian assistance [ , , ] . given these increased vulnerabilities in humanitarian settings, the united nations emphasized that diverting funds from addressing the unmet humanitarian needs of the most vulnerable people (especially the ultra-poor, children and elderly populations) in this pandemic era, would create a breeding ground for covid- to thrive and also lose gains made in the fight against already existing infectious disease epidemics, endemics and other public health emergencies [ ] . the question arises, "is nigeria, in particular, the northeastern region, prepared and ready to tackle yet another epidemic of covid- ? what is nigeria presently doing to stem the impact of a community transmission of the highly infectious disease-covid- , in already vulnerable and very challenging humanitarian context? ongoing response the answer to this, is, the federal government of nigeria is better prepared than ever before [ , ] . nigeria was among the first countries to recognize the risk and start planning ahead of the epidemic curve week after china first reported the cases of covid- [ ] . so far, the country have recorded giant strides in the fight against covid- by drawing on successes, and lessons learnt from controlling previous epidemics (such as ebola and polio), ongoing epidemics of lassa fever [ ] [ ] [ ] , followed by significant financial investments into preparedness, and surveillance from the federal government, and the newly formed nigerian private sector coalition against covid- [ ] . the federal government of nigeria through the presidential task force on covid- , federal ministry of health and nigeria center for disease control, have been working closely in collaboration with relevant ministries, departments, agencies, partners, and other stakeholders to coordinate and review the national response strategies and implementation activities, on a daily basis in order to effectively contain the spread of covid- [ , , ] . till date, several non-pharmaceutical measures have been employed to limit the importation of new cases, and control local transmissions. these measures include; staying at home, travel bans to, and from high-risk countries with community transmissions of covid- , border controls, deployment of rapid response teams to all affected states, state-level training and capacity building of health personnel on; infection, prevention and control; case management, intensified risk communication, community engagement, heightened surveillance, field epidemiological investigations, rapid identification of suspected cases, isolation, diagnosis, contact tracing, monitoring and follow-up of persons of interests [ , , ] . furthermore, social and religious gatherings were banned temporarily, schools and businesses were closed, restriction of movements and partial lock down were instituted in the federal capital territory, lagos, and ogun states [ , ] . the country has also established and expanded the diagnostic capacity for covid- in seven laboratories in months with plans to increase to more locations in the coming weeks [ , ] . in addition, the federal government of nigeria expanded its social safety net, and welfare programmes in its efforts to reduce poverty, and mitigate impacts of the unintentional partial-lock down on the livelihoods of the poor, and vulnerable households in affected states [ ] . food rations, food vouchers, conditional cash transfers, and other forms of palliatives targeted vulnerable, and socially disadvantaged members of the affected communities [ ] . in borno state (epicenter of the humanitarian crisis in northeastern nigeria), sensitization campaigns on handwashing were followed by the distribution of soaps to more than one hundred thousand internally displaced persons [ ] in consistent with peterson and colleagues' findings establishing the relationship between distribution of soaps in humanitarian settings with increased handwashing by over % [ ] . the united nations has recently called on all donors, partners and stakeholders to properly fund and support their global humanitarian respond plan to fight the common threat of covid- , by providing laboratory materials for testing, personal protective equipment for health workers, medical equipment to treat the sick, supplying water, and installing handwashing stations in camps and settlements [ ] . it is of extreme importance the nigerian government and stakeholders, continue to sustain and step up their commitment for mobilizing more public health resources to be better prepared and more proactive than ever to scale up covid- interventions and future epidemic preparedness and public health preventive measures for people affected by humanitarian crisis. more importantly, humanitarian actors, local, and international authorities are recommended to adopt the use of evidenced-based public health guidelines, such as the sphere handbook, to guide their response to the covid- pandemic in similar humanitarian context [ ] . can nigeria contain the covid- outbreak using lessons from recent epidemics? nigeria centre for disease control. ncdc initiates new measures for pandemic control as covid- spreads to states in nigeria centre for disease control covid- outbreak in nigeria situation report. available from: www.ncdc.gov nigeria overview humanitarian needs overview of nigeria nigeria's idps concerned about nigecovid- infection global humanitarian response plan for covid- afdb approves $ m package for who's africa response responding to the covid- pandemic in complex humanitarian crises why sub-saharan africa needs a unique response to covid- nigeria will deal with this": high alert after coronavirus case is africa prepared for tackling the covid- (sars-cov- ) epidemic. lessons from past outbreaks, ongoing pan-african public health efforts, and implications for the future preparedness and vulnerability of african countries against importations of covid- : a modelling study breakdown of contributions to fight covid in nigeria coronavirus -nigeria travel advice northeast development comission. sensitization campaigns on covid- the effect of soap distribution on diarrhoea: nyamithuthu refugee camp applying humanitarian standards to fight covid- publisher's note springer nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations the authors acknowledge the efforts of the federal government of nigeria and partners towards tackling the impact of covid- on vulnerable populations. none received.availability of data and materials not applicable.ethics approval and consent to participate not applicable. not applicable. all authors declare no conflict of interest.author details the first affiliated hospital, xi'an jiaotong university, xi'an , china. key: cord- - ndnqzv authors: oleribe, obinna o; osita-oleribe, princess; salako, babatunde l; ishola, temitope a; fertleman, michael; taylor-robinson, simon d title: covid- experience: taking the right steps at the right time to prevent avoidable morbidity and mortality in nigeria and other nations of the world date: - - journal: int j gen med doi: . /ijgm.s sha: doc_id: cord_uid: ndnqzv the coronavirus pandemic has caused countless governmental and societal challenges around the world. nigeria, africa’s most populous nation, has been exposed in recent years to a series of epidemics including ebola and lassa fever. in this paper, we document our perception of the national response to covid- in nigeria. the response to the pandemic is with a healthcare system that has changed as a result of previous infectious disease outbreaks but in the context of scarce resources typical of many low-middle income countries. we make recommendations regarding what measures should be in place for future epidemics. march , the world health organization (who) declared a pandemic caused by coronavirus disease , an infectious disease caused by severe acute respiratory syndrome coronavirus (sars-cov- ). since first being detected wuhan, china in december , the disease has rapidly escalated to over countries, leading who to declare the outbreak a "public health emergency of international concern" on january and eventually a pandemic within weeks. [ ] [ ] [ ] [ ] globally, as of april , , there have been , , confirmed cases of covid- and , related deaths giving a case mortality rate of . %. the pandemic took less than days to exceed one million confirmed cases by april , . the disease was first diagnosed in nigeria on february . as of april , , diagnostic tests had been conducted on , samples with confirmed cases. three hundred and nineteen patients had made a full recovery and had died, in test positivity, recovery, and case fatality rates of . %, . % and . %, respectively, throughout the country. globally governments have attempted to curtail the pandemic and curb its spread; with national lockdown, social distancing, regular handwashing, stay at home and self-isolation policies. these policies were captured in the who novel coronavirus ( -ncov): strategic preparedness and response plan, an objective of which is "to stop further transmission of -ncov within china and to other countries, and to mitigate the impact of the outbreak in affected countries." as the world comes to terms with this pandemic we begin to wonder if there anything that could be done better to minimize morbidity and mortality associated with the next pandemic. currently with more than three million cases and , deaths, there is a need to review and identify what strategies and activities could be started, continued or stopped, or continued more effectively and efficiently to minimize the impact of the next pandemic. this paper will discuss the strategies that were applied in nigeria and those that should be applied in the future. meetings were held daily by the eoc and meetings were held in individual states to curtail the outbreak. hospitals were assessed and activated as isolation and treatment centers, laboratories were equipped to test for the virus using pcr technology and staff were trained to manage cases, test patients, track contacts, and document findings. despite all these measures, at present, the number of cases continues to rise. this has led us to review our current practice to identify what can be put in place to prevent similar epidemics in the coming years. in addition, we present some immediate strategies that could reduce covid- infection. early in any outbreak, there is need to conduct a quick and immediate assessment of resources and current activities. this assessment should appraise available resources, and all relevant public health activities and outputs. and what lessons can we learn from elsewhere? these questions will also analyze the strength, weaknesses, opportunities and threats of the control system and processes. this will provide background information for the next phase of programing. beyond a national incident management team (nimt), there is a need to concurrently establish regional or state incident management teams (r/simt). each team will include the regional/state epidemiologist, highly experienced laboratory manager, communication officer, chief medical officer of a reference facility or tertiary hospital in the region/state, and a finance officer/manager. at the national level, a national imt will comprise a director, presidential task force; director general, national centre for disease control; director, emergency and preparedness; project manager/consultant; communication officer and research lead. these incident managers must be quickly constituted, mobilized and operationalized proactively to ensure immediate roll out of protocols, guidelines and standard operating procedures like those developed in nigeria by the nigeria centre for disease control (ncdc). capacity development of all members of the imt is critical to ensure the quality of services provided, safety of the frontline workers and health of patients. all imts should be trained on developed guidelines, protocols, standards of practice, and algorithms. all training should be virtual to minimize physical contact and traveling. this training should be facilitated by highly qualified persons from international organizations where available and relevant university departments in the country, region or state. in-person training should be reduced to the barest minimum. oleribe et al dovepress submit your manuscript | www.dovepress.com international journal of general medicine : to control an outbreak, screening and testing must be available. where the resources are available, polymerase chain reaction (pcr) empowered laboratories should be established in each region/state. these can be established in partnership with the governments of the regions/states and corporate organizations. regions/states with the capacity should establish one laboratory per county/senatorial district. eventually, the development of antigen-antibody testing can minimize the use of (pcr) techniques which are usually expensive and require a high level of technical skill. as quickly as possible, states should move from facility-based pcr to community-based antigen-antibody testing using rapid test kits. each outbreak should be an opportunity to develop the capacity of local partners to create new testing centers and build the capacity of healthcare workers to screen and test. to support the testing and diagnosis facilities, sample collection centers (scc) should be established in all communities across the nation. simple test strips should be introduced as quickly as possible for screening purposes, and positive samples referred for confirmation at the nearest specialist center. funds are needed to manage outbreaks particularly to protect the vulnerable communities. budgetary allocations from the national government can jumpstart the process. however, both the imts and control organizations should be fast in seeking and obtaining funds from non-government sources. donors can reprogram funds towards the management of the outbreak. regions, states, corporate organizations and individuals can fund the establishment of laboratories, procurement of test kits, training of healthcare workers, engagement of volunteers and even establishment of isolation and quarantine centers. beyond screening and stand-alone testing sites, outbreaks like covid- should have integrated management systems. this will involve the establishment of integrated diagnosis, isolation and treatment (dit) centers in all regions/states where none exist. the goal would be to have a dit center within a -km radius. this can be started with one per region/ state. self-isolation should be discouraged, and exposed people should be asked to be isolated in government-designated dit locations. new dits could be located in community halls, open spaces, stadia, hotels, etc. this strategy is designed to take the outbreak (like covid- ) out of the hospitals. taking the outbreak out of the hospitals will allow the secondary and tertiary hospitals to manage the conventional illnesses and diseases common in each locality. each dit can have from to beds to accommodate isolation cases. dit centers will decentralize testing, isolate and manage cases, as well as relieve the burden on hospital facilities across the nations of the world. to overcome a global outbreak, healthcare workers should be mobilized and utilized strategically to achieve the agenda of expanding testing, preventing infection, and forming effective partnerships in the community. this requires mobilization of volunteer healthcare workers and other support-staff from relevant organizations. doctors, nurses, pharmacies, laboratory scientists, community health workers, and support staff should be mobilized to volunteer as frontline workers to manage the dit centers in each location. more volunteers will be placed where they are needed most. volunteers should be managed and supervised by the relevant imts and trained virtually. trained volunteers and healthcare workers should be empowered and supported to train others, scale up and scale out services. they will also help to screen at community level, track contacts of confirmed cases and participate in facility readiness assessment. finally, they should be engaged in community education and information management. information management is critical to outbreak management and control. using relevant technological applications and platforms, up to date information on an outbreak locally and nationally can be monitored. also, through surveys such as the broadreach vantage , an assessment can be made of the impact of the intervention, community knowledge base, and attitude and practice of people. confirmed cases can be used to conduct trials to understand causality analysis, what is effective, and experiment with different antiviral/antibiotics/antiparasitic combinations to identify what works best among the population. it should be possible to collect data about complications, length of stay in hospital, antigen and antibody conversion rates and factors that influence them; and investigate factors associated with various degrees of infection and manifestations. publications will promote global information sharing and allow nations just beginning to experience the outbreak to know what works to help curb the spread of the virus. the various strategies cannot stand alone but can be executed concurrently based on the identified and agreed timelines. there should be daily virtual meetings by the imt to assess progress and make mid-course corrections; weekly virtual meetings to generate new ideas and review weeklong activities while finalizing the next week project; weekly publications of activities, finances, and lessons learned; and weekly m&e questionnaire completion and analysis. active use of everyday data gathered during the process of the outbreak investigation, the clinical presentation and epidemiology of the disease can be readily characterized including the use of data science, projections/modelling and data visualization. the nigerian government responded to the covid- pandemic by various measures affecting the population and the creation of necessary national teams to provide structure and leadership. these teams interfaced with the country to discuss the plan for treatment and control of the pandemic in nigeria. in the recovery from covid- medical authorities need to integrate their responses in a coordinated and streamlined way to prevent silo or vertical reactions to crises. lateral and coordinated thinking is required. the lessons learnt from the covid- pandemic need to be implemented in policy documents to ensure readiness to prevent future, similar world crises. we need to build the relevant structures and partnerships to ensure we fight locally and win globally. public health emergency of international concern declared who. who director-general's statement on ihr emergency committee on novel coronavirus who characterizes covid- as a pandemic director-general's opening remarks at the media briefing on covid- - covid- infections hit one million mark; countries must protect health & livelihoods during covid- pandemic say who and imf covid- ) highlights: case summary in nigeria as at covid- : nigeria announces lockdown of major cities novel coronavirus ( -ncov): strategic preparedness and response plan ncdc. guidelines & protocols. available from launch of free online introductory course on the novel coronavirus global community asks for us$ million to help protect vulnerable countries from outbreak broadreach corporation the authors acknowledge the work of the national emergency outbreak committee led by dr chikwe ihekweazu and incident manager john oladejo. we also acknowledge the work of the presidential task force (ptf) led by boss mustapha and dr sani aliyu, and all the frontline healthcare workers who have put themselves at risk to control and contain the pandemic. we thank the efmc, cfhi and hs team for their work during this period.mf and sdtr are grateful to the nihr biomedical facility at imperial college london for infrastructural support. sdtr was supported by a wellcome trust issf grant at imperial college london. the authors report no conflicts of interest in this work. key: cord- -rnley ow authors: ibrahim, r. r.; oladipo, o. h. title: forecasting the spread of covid- in nigeria using box-jenkins modeling procedure date: - - journal: nan doi: . / . . . sha: doc_id: cord_uid: rnley ow abstract objective: this study is focused on the analysis of the spread of covid in nigeria, applying statistical models and available data from the ncdc. we present an insight into the spread of covid in nigeria in order to establish a suitable prediction model, which can be applied as a decisionsupportive tool for assigning health interventions and mitigating the spread of the covid infection. methodology: daily spread data from february to april , , were collected to construct the autoregressive integrated moving average (arima) model using the r software. stability analysis and stationarity test, parameter test, and model diagnostic were also carried out. finally, the fitting, selection and prediction accuracy of the arima model was evaluated using the aicc model selection criteria. results: the arima ( , , ) model was finally selected among arima models based upon the parameter test and box ljung test. a ten day forecast was also made from the model, which shows a steep upward trend of the spread of the covid in nigeria within the selected time frame. conclusion: federal government of nigeria through the presidential task force can apply the forecasted trend of much more spread to make more informed decisions on the additional measures in place to curb the spread of the virus. application of the model can also assist in studying the effectiveness of the lockdown on the on the spread of covid in nigeria. covid- has been spreading rapidly globally, with a considerable impact on global morbidity, mortality and healthcare utilization. this viral disease is caused by the coronaviruses (cov) which belong to the genus 'coronavirus' of the coronaviridae family. all covs are pleomorphic rna viruses characterized by crown-shape (the name "coronavirus" is derived from the greek κ ο ρ ώ ν α , meaning crown.) peplomers with - nm in size and the genome of cov contains a linear, single-stranded rna molecule of positive (mrna) polarity and about - kb in length (sahin, ; woo, huang, lau, & yuen, ) . coronaviruses possess the largest genomes among all identified rna viruses, and the large genome gives the virus extra plasticity in accommodating and modifying genes. hence high recombination rates are observed in covs due to constantly developing transcription errors, and rna dependent rna polymerase (rdrp) jumps (woo et al., ) . coronaviruses are zoonotic pathogens, found in humans and various animals with the ability to exhibit clinical features in human. in humans, there are four prototypic human cov (hcov) that cause endemic and epidemic respiratory disease, including the human alpha coronaviruses e and nl and the human beta coronaviruses oc and hku (drexler et al., ) . infected patients can be asymptomatic or symptomatic affecting the gastrointestinal, respiratory, hepatic and neurological systems and may result in hospitalization at the intensive care unit (drexler et al., ; woo et al., ; yin & wunderink, ) . the history of the pathogenicity of cov is dated back to and when they were considered to be highly pathogenic due to severe acute respiratory syndrome (sars) in guangdong state of china for the first time. before this outbreaks, the two most common cov known to cause mild infections in people with the adequate immune system includes cov oc and cov e (peiris et al., ; yin & wunderink, ) . about ten years after sars, the highly pathogenic cov, middle east respiratory syndrome coronavirus (mers-cov) emerged in the middle east countries (zaki, van boheemen, bestebroer, osterhaus, & fouchier, ) and recently in december , a novel coronavirus (ncov) emerged at a livestock/seafood market in the wuhan state of hubei province in china and has evolved into a global pandemic ("seven days in medicine," ). chinese authorities announced the isolation of this novel virus on january , the virus was named covid- by the world health organization on january , , and as at february , , a total of , confirmed cases and , deaths had been reported (organization, ) . during the ongoing pandemic, some research publications have focused on the epidemiology, trend analysis and forecasting for different cities and countries. these studies presented long-term and short-term trend using time series data from relevant database and offered forecasting applications using models such as arima model, exponential smoothing methods, seir model and regression model. applying purely data-driven statistical method, yang et al., ( ) estimated the case fatality rate (cfr) for covid- in three clusters: wuhan city, other cities of hubei province, and other provinces of mainland china. a simple linear regression model was applied to estimate the cfr from each cluster. the result obtained showed that cfr during the first weeks of the epidemic ranges from . % ( % ci: . - . %) in mainland china excluding hubei through . % ( % ci: . - . %) in hubei province excluding the city of wuhan to . % ( % ci: . - . %) in wuhan. their results conclusively indicate cfr of covid- is lower than the previous coronavirus epidemics caused by sars-cov and middle east respiratory syndrome coronavirus (mers-cov). to study the epidemic trend of covid- in mainland china, hubei province, wuhan city and other provinces outside hubei from january to february , , zhu et al., ( ) generated the epidemic curve of the new confirmed cases, multiple of the new confirmed cases for period-over-period, multiple of the new confirmed cases for fixed-base, and the period-over-period growth rate of the new confirmed cases using data from national health commission. from january to february , , the cumulative number of new confirmed cases of covid- in mainland china was , including in hubei province, in wuhan city and , in other provinces outside hubei. the peak of the number of new confirmed cases in other provinces outside hubei was from january to february , , and the peak of new confirmed cases in wuhan city and hubei province was from february to february , . the number of new confirmed cases in other provinces outside hubei showed a significant decline ( % compared with the peak) from february to february , , while the number of new confirmed cases in wuhan city ( % compared with the peak) and hubei province ( % compared with the peak) decreased significantly from february to february , . fanelli & piazza, ( ) analyzed the temporal dynamics of covid- outbreak in china, italy and france with the timeframe of january to march . a first analysis of simple day-lag maps points to some universality in the epidemic spreading and the analysis of the same data within a simple susceptible-infected-recovered-deaths model indicates that the kinetic parameter that describes the rate of recovery appears to be the same, regardless of the country, while the infection and death rates appear to be more variable. the model places the peak in italy around march , , with a peak number of infected individuals of about (not including recovered and dead) and a number of deaths at the end of the epidemics of about , . since the confirmed cases are believed to be between and % of the real number of individuals who eventually get infected, the apparent mortality rate of covid- falls between % and % in italy, while it appears substantially lower, between % and % in china. piccolomini & zama, ( ) also proposed the modification of the susceptible-infected-exposed-recovered-dead (seird) differential model for the analysis and forecast of the covid- spread in some regions of italy. they introduced a time-dependent transmitting rate and reported the maximum infection spread for the three italian regions firstly affected by the covid- outbreak (lombardia, veneto and emilia romagna). danon, brooks-pollock, bailey, & keeling, ( ) applied an existing national-scale metapopulation model to capture the spread of covid- in england and wales. they captured data from population sizes and population movement, together with parameter estimates from the current outbreak in china and were able to predict the peak of the outbreak after person-person transmission was established in england and wales. jit et al., ( ) applied exponential growth model to fit critical care admissions from multiple surveillance to study likely covid- case numbers and progress in the united kingdom from february -march , . they estimated that on march, there were , (median; % credible interval , - , ) new cases and ( - ) new critical care reports, with , ( , - , ) cumulative cases since february . on february , , nigeria recorded its first case of covid- . the index case was an italian citizen who arrived nigeria via the murtala muhammed international airport, lagos at pm aboard turkish airline from milan, italy. . cc-by-nc-nd . international license it is made available under a is the author/funder, who has granted medrxiv a license to display the preprint in perpetuity. the copyright holder for this preprint this version posted may , . . https://doi.org/ . / . . . doi: medrxiv preprint on march , , the second case of covid- was reported in nigeria, this was a contact of the index case, and as the days and weeks progressed, the number of confirmed cases of covid- increased stemming from both local transmission and importation from other countries. as of march, , the total confirmed cases within nigeria had risen to (ninety-seven) and had recorded its first death on march . the federal government on march , , announced a lockdown on lagos, ogun states and the federal capital territory (fct) with effect from pm of march , . lagos state is the epicentre of the disease and ogun state being its boarder state while fct had the second highest of confirmed covid- cases in the country. the government had also imposed travel restriction into the country for travellers from china, italy, iran, south korea, spain, japan, france, germany, the us, norway, the uk, switzerland and the netherlands on the march , . it expanded these restrictions on march , as the nation closes its two main international airports in lagos and abuja. the country also suspended rail services on march , . as the number of cases grew nationwide in nigeria and local transmission surged relative to the number of imported cases, there is a need to focus on more local measures to decrease the spread of covid- . in addition to the lockdown, social distancing rule has been enforced by cancelling mass gatherings, closing businesses except for providers of essential goods and services such as food and pharmaceutical entities and restriction of local travels. using mathematical and statistical models as described in other studies above, study of the trend of the covid- pandemic in nigeria can provide critical information for responding to outbreaks and understanding the impact of strategies employed by the government in containing the spread of the disease. this present study focuses on the analysis of the trend of spread of covid- in nigeria, identification and application of befitting trend prediction models using available data from the ncdc. overall, we were able to formulate time series models on the spread of covid- in nigeria, conduct a diagnostic check on the models formulated to determine the most suitable model, estimate the parameters of the various models and forecast the covid- spread variable. data comprising confirmed, recovered, and death cases as variables; were retrieved from the nigeria centre for diseases control (ncdc) official covid- site (https://covid .ncdc.gov.ng/). the data refer to daily cases and cover the period from february , , when the country recorded her index case until april , . this data set included both "lab-confirmed" and "clinically diagnosed" cases. we emphasize the importance of the recovered cases, which is not covered in media as widely as the confirmed cases or the deaths. while, only the confirmed cases variable shows an exponential increase, most especially in the month of march . however, the curve of recovered cases is flattened over the past days of the study period. applying the obtained data, we adopted a non-stationary time series forecasting approach. since the series is obtained over a relatively short period of time and also of a very high frequency (daily data), the box-jenken procedure (musa, ; yue, shengnan, & yuan, ) was employed. forecasts were made using the autoregressive integrated moving average (arima) model's family. this family has shown good forecast accuracy over several forecasting competitions and is especially suitable for short series. this model encompasses the ar, ma or arma models in which differences have been taken and collectively called autoregressive integrated moving average models, or arima models. a time-series {y t } is said to follow an integrated autoregressive moving average thus, an arima (p, , q) process. or, in terms of the observed series, ... cc-by-nc-nd . international license it is made available under a is the author/funder, who has granted medrxiv a license to display the preprint in perpetuity. the copyright holder for this preprint this version posted may , . . https://doi.org/ . / . . . doi: medrxiv preprint stationary test and jarque-bera test for normality were applied as a prerequisite for the application of the arima time-series model (sato, ; wu, guan, guo, & zhou, ) . statistical approaches for model selection (such as information criteria, which measure the maximum likelihood of a model) was used to select the model that better reflect the nature of the data, thus model with the best model's selection criterion. we produce ten-days-ahead point forecasts and prediction intervals and update our forecasts every ten days. please note that this is not an ex-post analysis, but a real, live forecasting exercise. the r. console . . version statistical software was used for this study's data analysis. the overall distribution data of covid- from february , to april , , were collected and analyzed. a total of covid- cases were observed from february , to april , , and the incidence showed a wave-like increasing tendency day by day, with the trend of rectilinear rise after march , , when the first lockdown was enacted by the federal government of nigeria. the recovery rate as of april , , was . %, which stood for the peak incidence and recovery ratio since the index case of covid- in nigeria. sequence characteristic analysis and transformation: firstly, a daily sequence from february , to april , , was calculated and its chart was drawn, as shown in figure a the original sequence showed a mixed trend of an upward or downward trend with a seasonal cycle rhythm, which was not smooth and had uneven variances. the original sequence was transformed into a random one through the methods of first difference transformation and once seasonal di erence successively. after that, the time sequence displayed a random and stationary trend ( figure b and table ). as is shown in figures (a-b) , a total of cases on april , , represented the peak daily report of covid- since the index case in nigeria. to effectively apply the arima modelling technique, the series must be stationary and free of any form of trend. to confirm the status of the series (daily confirmed cases of covid in nigeria), the adf test was thus use to validate the stationarity observed from the series transformation (adf test: t= - . and p < . ) ( table ) , thus making the series obtaining stationarity at st difference. the series was however not observed to be stationary at level, which is the natural state of the data, then we transformed the series to make stationary by first difference. this makes the series stationary and ready for modelling inline the box-jenken arima modelling approach. a list of candidate models or potential model combinations will be obtained from the plots of the autocorrelation function (acf) and the partial autocorrelation function (pacf). the order of the model was determined according to acf and pacf after once common di erence. based on the spikes observed from the acf and pacf chart, the following candidate models are formulated. the candidate model with the lowest akaike information criterion correction (aicc) value was selected as the best model to fit the daily spread series of covid- in nigeria. from the acf and pacf graph (as shown in figure above) and the models trace summary table (table ) , we were able to observe the following candidate models and also using the aicc model selection criterion, we detect that the arima( , , ) with drift as the model with lowest aicc value. as observed from the above table, the best model of the candidate models is the arima ( , , ) base on the aicc criterion. the model is then estimated with its parameter estimates for forecasting the daily spread series of covid in nigeria. . cc-by-nc-nd . international license it is made available under a is the author/funder, who has granted medrxiv a license to display the preprint in perpetuity. the copyright holder for this preprint this version posted may , . . https://doi.org/ . as shown in figure , the daily spread data from april to may , , were predicted using the arima( , , ) model based on the spread of covid- in nigeria from february to april , , the results of which suggested that the predicted values fitted well with the actual values. the forecast table above contains the date, point forecast and the high and low confidence limits values of the forecast. the daily forecast is the point forecast but can be with the % confidence limit of the hi and lo values on the table. there was no case of covid- in nigeria until february of . since then, covid- cases have been reported daily by the ncdc and on an uptrend. following the current global strategies aimed at limiting the spread of the coronavirus, most countries, including nigeria, have restricted movements and asked people to maintain social distancing and globally about billion persons are currently being confined in one way or another. due to high illiteracy and poverty rate in most developing countries, there is need to understand the trend of the spread of covid- and extrapolate the implications of the strategies employed by the government in curbing the spread of the disease. time-series analysis is a method to extrapolate predictions, in which a mathematical model is established according to the regularity and trend of the observed historical values with time (l. liu, luan, yin, zhu, & lü, ; q. liu, liu, jiang, & yang, ) and has been widely used in predicting the spread of infectious diseases in recent years. for instance, some scholars have used this model to predict the spread of tb, mumps, measles, encephalitis b, and hand-foot-and-mouth disease (allard, ; jiabing, ; jin et al., ; musa, ; wu et al., ; yue et al., ) . these diseases are similar to covid- in time distribution (organization, ; peiris et al., ; sahin, ) . in this study, applying time series models as described above, to study the trend of the covid- pandemic in nigeria. candidate models were obtained using the autocorrelation function (acf) and the partial autocorrelation function (pacf), models were formulated based on the spikes observed from the acf and pacf chart (figure ). arima ( , , ) was confirmed to be the optimal model based on the lowest aicc value. this model was then applied to study the trend of covid- from april , to may , . the incidence of covid- from april to may , , shows an increasing growth steep in nigeria ( . , % confidence limit of . - . ), which peak cannot be said to have been seen or reached yet. according to these results, we must be alert of the possibilities of covid- spreading more than its currently observed as seen from the models' prediction. the proposed ease of lockdown restrictions by the federal government is expected to commence on may , , and there is no indication of the trend to expect following the ease on restrictions. countries like germany have experienced an increased number in covid positive cases after easing the country's restrictions. based on our study's result, the trend of the spread of covid- in nigeria is expected to move in a upward trend. having established a suitable model, nigeria can apply this model to predict the trend of covid- in the country. . cc-by-nc-nd . international license it is made available under a is the author/funder, who has granted medrxiv a license to display the preprint in perpetuity. (which was not certified by peer review) the copyright holder for this preprint this version posted may , . . https://doi.org/ . government through the constituted presidential task force should be conscious of the wider spread if nothing is done as an addition to current lockdown for it is evident that the lockdown is not reducing the covid- spread as expected. use of time-series analysis in infectious disease surveillance-bulletin of the world health organization genomic characterization of severe acute respiratory syndrome-related coronavirus in european bats and classification of coronaviruses based on partial rna-dependent rna polymerase gene sequences prediction of incidence of notifiable contagious diseases by appalication of time series model forecasting incidence of intestinal infectious diseases in mainland china with arima model and gm ( , ) model comparison of arima and random forest time series models for prediction of avian influenza h n outbreaks predicting the incidence of hand, foot and mouth disease in sichuan province, china using the arima model forecasting incidence of hemorrhagic fever with renal syndrome in china using arima model malaria disease distribution in sudan using time series arima model coronavirus disease . world health organization coronavirus as a possible cause of severe acute respiratory syndrome novel coronavirus (covid- ) outbreak: a review of the current literature disease management with arima model in time series coronavirus genomics and bioinformatics analysis. viruses comparison of gm ( , ) gray model and arima model in forecasting the incidence of hemorrhagic fever with renal syndrome mers, sars and other coronaviruses as causes of pneumonia. respirology application of arima model on predicting monthly hospital admissions and hospitalization expenses for respiratory diseases isolation of a novel coronavirus from a man with pneumonia in saudi arabia key: cord- - pmvftgk authors: chirove, f.; madubueze, c. e.; chazuka, z.; madubueze, s. c. title: a model assessing potential benefits of isolation and mass testing on covid- : the case of nigeria date: - - journal: nan doi: . / . . . sha: doc_id: cord_uid: pmvftgk we consider a model with mass testing and isolation mimicking the current policies implemented in nigeria and use the nigerian daily cumulative cases to calibrate the model to obtain the optimal mass testing and isolation levels. mathematical analysis was done and important thresholds such the peak size relation and final size relation were obtained. global stability analysis of the disease-free equilibrium indicated that covid- can be eradicated provided that $mathcal{r}_ < $ and unstable otherwise. results from simulations revealed that an increase in mass testing and reduction of transmission from isolated individuals are associated with benefits of increasing detected cases, lowering peaks of symptomatic cases, increase in self-isolating cases, decrease in cumulative deaths and decrease in admissions into monitored isolation facilities in the case of nigeria the novel coronavirus disease (covid- ) is the world's recent pandemic. it is a highly contagious disease caused by severe acute respiratory syndrome coronavirus- (sars-cov- ) [ , ] that belongs to the same family with severe acute respiratory syndrome coronavirus (sars-cov), and middle east respiratory syndrome coronavirus (mers-cov) which are known to cause pneumonia in humans [ , , , ] . the first outbreak in wuhan, china in december has since spread to the rest of the world [ , , ] which saw it being declared a world pandemic in [ , ] currently, there are over million confirmed cases, over thousand deaths and close to million recoveries. africa alone has over one million confirmed cases, about thousand deaths and about thousand recoveries. nigeria currently is the third highest contributor to the african burden with about thousand confirmed cases, close to a thousand deaths and over thousand recoveries [ ] . the covid- primary source of transmission was firstly suspected to be from wild animals to humans but in nigeria and the rest of africa, the primary source was patients infected with covid- travelling into the continent [ , , ] in general, covid- case fatality is low but people with co-morbidities like diabetes mellitus, cancer, chronic obstructive pulmonary diseases, and hypertension are at high risk of covid- fatalities. the routes of transmission for sars-cov- are respiratory droplets (generated via sneezing and coughing), close contact with an infected person, contact with environmental surfaces and aerosols. successful infection by a virus occurs when adequate viral load enters the body, penetrates the target cells, replicates and gets released to infect more cells [ ] . the symptoms of covid- illness are fever, dry cough, and fatigue, headache, haemoptysis, diarrhoea, difficulty with breathing and muscular pain [ , , ] . severe disease is characterised by acute respiratory syndrome, acute cardiac failure, acute kidney failure, anaemia, stroke, multiple organ dysfunction, and secondary bacterial infection [ ] . the current preventive methods, among others, are maintaining physical distancing, observing cough etiquette, quarantine, isolation and community lock downs [ , ] . the incubation period of sars-cov- has been estimated to range from to days [ ] . available evidence showed that covid- human-to-human transmission occurs during the asymptomatic incubation period which is usually to days [ ] . this suggests that for any systems to control the infection effectively, the asymptomatic individuals should be subjected to testing so that preventive measures such as self and mandatory isolation can be effected to reduce the spread of the infection. community mass testing is one of the strategies that can be used to identify infected individuals. isolation is the separation of persons with contagious disease from those not infected [ ] . the infected individuals can be isolated in hospital settings for severe and critical diseases while sub-clinical infections can stay at home. for isolation to be effective in halting transmission, cases should be identified before the onset of viral shedding or at least before the onset of peak viral shedding [ , ] . one of the effective testing instruments is the use of real time polymerase chain reaction (rt-pcr) [ , ] which was used effectively among sheltered people in boston, usa and south korea on the asymptomatic population to reduce the risk of community transmissions instead of focusing only on those with severe symptoms or high risk groups [ ] . it has been argued that a populationwide mass testing would help identify individuals that are likely to transmit disease long before symptoms appear [ ] . thus, the fight against covid- is a war against an invisible enemy which requires rapid detection of those that can transmit the infection and quickly isolate them before viral shedding commences. covid- sufferers can be classified into three groups: sub-clinical (asymptomatic and mild symptomatic) infections, severe disease, and critical disease [ ] . the first two groups accounts for approximately % of cases and usually resolve without any pharmacologic intervention [ ] . they pose serious danger to containment because they can transmit the virus without being aware of their status. this group often refuses isolation from the community and even when isolated, may attempt to escape from the isolation centre and can recover without any intervention. those with severe disease account for % and would require hospitalization, supportive and pharmacologic therapies while those with critical disease account for the remaining % requiring nursing in the intensive care unit with ventilator [ ] . treatment administration remains largely supportive therapy [ , ] . our study seeks to assess the potential impact of isolation and mass testing of the population on the transmission of covid- in nigeria using mathematical modelling approach. we present the background setting for nigeria henceforth. nigeria has a population of , , persons as of may [ ] . the nigeria covid- cases started with an imported case of a -year-old italian citizen who presented himself to the staff clinic on the th of february and was later confirmed as the first official case of covid- in nigeria on the th of february . contact tracing for the index case identified about asymptomatic who were tested and produced one confirmed positive making it the second case of covid- on the th of march . more imported cases were reported in march and since then the infection rose to current aforementioned pandemic levels in nigeria [ , ] . the first covid- related death was recorded on the nd of march and the fatality was due to co-morbidities complications. cumulative confirmed cases in figure are used for calibration of the mathematical model. the lock down was announced by nigeria government effected measures such as travel bans from his risk countries and as well as lock down in order to halt the community spread of the covid- . the initial lock down was in lagos, abuja, and ogun states on the th of march and later extended to other . cc-by-nc-nd . international license it is made available under a perpetuity. is the author/funder, who has granted medrxiv a license to display the preprint in (which was not certified by peer review) preprint the copyright holder for this this version posted september , . . https://doi.org/ . / . . . doi: medrxiv preprint [ ] . mass testing is yet to take effect in nigeria. as of august , nigeria has carried out , sample tests which is small for a country with over million people [ ] . this poor testing capacity makes the epidemic curve not flatten in nigeria. nigeria has about laboratories for covid- testing. the testing is for three categories of people, those with travelling history outside nigeria and symptoms within days of arrival, those with contact with confirmed case and symptoms, and those with symptoms and stay in high prevalence of covid- area in nigeria. [ , ] a number of mathematical models for covid- have so far been established which looked at the different effects of intervention strategies and predict the probable outcomes of the pandemic. the studies presented in [ , , , , , , , , , ] used the standard seir compartmental structure to model the various aspects of covid- dynamics interventions. however, the studies in [ , ] points out the inadequacy of the framework and presented improved frameworks which included the quarantined classes as well as the dead compartments. the results from all the aforementioned studies focused on the benefits of control measures such as quarantining, travel restrictions and social distancing, among others but did not take into consideration the effects of the asymptomatic infectious individuals as these are one of the major undetected cases that are drivers of infection. to detect this group of individuals, measures such as mass testing and isolation will need to be implemented. checchi et al. is the author/funder, who has granted medrxiv a license to display the preprint in (which was not certified by peer review) preprint the copyright holder for this this version posted september , . . https://doi.org/ . / . . . doi: medrxiv preprint social distancing and shielding in the reduction of covid- cases in africa using data from mauritius, nigeria and niger. they concluded that isolation and social distancing were effective when subjected to lock down conditions. our current work on the dynamics of the novel covid- virus in nigeria uses a deterministic modelling approach to estimate the potential impact of self and mandatory isolation, and mass testing. the organisation of the paper is as follows: in section we present the model formulation of our deterministic mathematical model for covid- dynamics in nigeria, section presents fundamental properties of the model, threshold computation and equilibrium stability analysis. we formulate a mathematical model to study the dynamics covid- incorporating mass testing and, self and mandatory isolation. we consider a homogeneously mixing population that comprises of the following compartments: the susceptible population s(t), the exposed population with the virus but not yet able to transmit it to other individuals e(t), infectious asymptomatic population not yet tested i a (t), infectious asymptotic population that has been tested and self isolating i at (t), infectious symptomatic population i s (t), infectious symptomatic isolated population under health care enclosures and monitoring j(t) and the removed population r(t). we assume that mass testing mostly affects those in classes i a (t), i s (t) mainly because these are the only classes where individuals test positive. individuals in s(t) and e(t) and r(t) will test negative and thus, will remain in the same class as the ones untested. individuals in i s (t) as soon as they test positive are immediately transferred into isolation centres and hence, are assumed not to self isolate. the total human population n (t) is since covid- is a respiratory , we leave out the demographic parameters and concentrate on the infection and intervention dynamics due to differences in time scales of occurrence between demographic and infection dynamics. the force of infection for the model is assumed to be where β is the effective transmission rate of covid- and η , η , η are modification parameters where > η > η > η ≥ which quantify the contribution of each infectious class compared to the most infectious ones. thus, individuals that are symptomatic and not tested or isolated in class i s are more infectious than individuals in class i at and those in class j. exposed individuals e(t) will progress into the i a (t) and i s (t) at rates σ( − ) and σ respectively where σ is the rate of progression and ∈ [ , ] is the proportion of individuals from e(t) that develop symptoms. due to mass testing, some . cc-by-nc-nd . international license it is made available under a perpetuity. is the author/funder, who has granted medrxiv a license to display the preprint in (which was not certified by peer review) preprint the copyright holder for this this version posted september , . . https://doi.org/ . / . . . doi: medrxiv preprint individuals in i a (t) test positive and are required to self isolate progressing to the class i at (t) with a probability rate of detection due to mass testing γ and they can recover from the infection and move to the removed class r at a rate ω. those in class i s (t) of symptomatic individuals either progress to mandatory isolation at a rate δ = γ + φ or recover from the infection at rate ζ. here, φ is the isolation rate due to the individuals visiting the health care centres before mass testing detection and γ is the probability rate of detection due to mass testing of i s population. they can also die due to covid- induced death at a rate d . individuals in the i at (t) class can either progress to the mandatory isolation care centers after developing symptoms at a rate pδ, where p is the probability that an individual in i at (t) develops symptoms. they can also recover at a rate α and move to r. individuals in the j class can either recover at a rate ν or die due to the virus at a rate d . the flow diagram of the model with the aforementioned assumptions is in figure and the governing equations are given by systems of equations ( ). ( ) the model ( ) has initial conditions given by is the author/funder, who has granted medrxiv a license to display the preprint in (which was not certified by peer review) preprint the copyright holder for this this version posted september , . . https://doi.org/ . / . . . doi: medrxiv preprint Ω = {(s(t), e(t), i a (t), i at (t), i s (t), j(t), r(t)) ∈ r + | < n (t) ≤ n } results model ( ) describes dynamics of covid- within the human population and therefore it is important and necessary to prove that all the variables used in the model (s(t), e(t), i a (t), i at (t), i s (t), j(t), r(t)) are non-negative for all time and also that solutions for model system ( ) with positive initial data will remain positive for all time and are bounded in Ω. ( ) with nonnegative intial conditions are positive for all t ≥ . proof solving the first equation of model system ( ) using the separation of variables method we have it is easy to follow a similar analysis to show that the other state variables e(t), i a (t), i at (t), i s (t), j(t), r(t) are non-negative for all t > . based on this we conclude that the solutions of model system ( ) remain positive for all t ≥ and this completes the proof. proof considering the total population for model system ( ) n (t) we have by the positivity of i s and j. the solution to the differential inequality using intial conditions n ( ) = n is given by hence, we conclude that n (t) is bounded above and all state variables are bounded. the region Ω, in which the solutions of model system ( ) are restricted is therefore a feasible region. is the author/funder, who has granted medrxiv a license to display the preprint in (which was not certified by peer review) preprint the copyright holder for this this version posted september , . . https://doi.org/ . / . . . doi: medrxiv preprint the disease free equilibrium point is given by (n , , , , , , ) . using the next generation matrix approach by [ ] , our model satisfy the conditions a to a and the basic reproduction number r is given by r s is a local reproduction number that measures the secondary infections that arise when the index case is a symptomatic infectious individual, r s is a local reproduction number that measures the secondary infections that arise when the index case is an asymptomatic infectious individual not tested, r at is a local reproduction number that measures the secondary infections that arise when the index case is an asymptomatic infectious individual who has been tested and self isolating and r j , is a local reproduction number that measures the secondary infections that arise when the index case is an isolated infectious individual. it follows from the fact that the model satisfy conditions a to a of [ ] that the disease free equilibrium is stable when r < and unstable when r > . hence, the stability theorem below holds theorem the disease free equilibrium point e for model system ( ) is locally asymptotically stable provided that r < . in relation to controlling the novel covid- virus, isolation has been one of the major worldwide control measure with most countries enforcing lock downs to the general susceptible population and mandatory isolation for infected individuals. in epidemic modelling quantities such as the reproduction numbers r , r e , peak size and final peak size of the epidemic, are important in providing epidemiologists with useful information on the effects of such control measures on the dynamics of infection within the population [ ] . we consider an epidemic that started as a result of an infected visitor from outside the population. the population is a completely susceptible population of size n ≈ s . we use feng et al. [ ] to calculate the peak size of the pandemic and the simple kermack-mckendrick model approach in the work by fred brauer [ ] to calculate the final size relation for covid- as shown below. the population is a completely susceptible population of size n ≈ s . is the author/funder, who has granted medrxiv a license to display the preprint in (which was not certified by peer review) preprint the copyright holder for this this version posted september , . . https://doi.org/ . / . . . doi: medrxiv preprint to determine the peak of the epidemic we define a weighted infected sum y(t) as where the infected compartments e(t), i a (t), i at (t), i s (t) and j(t) are considered since they contribute to the infection. now differentiating ( ) with respect to t yields and substituting e (t), i a (t), i at (t), i s (t) and j (t) from system ( ) into ( ) and simplifying yields hence, dividing y (t) by s (t) of model system ( ) yields where n = n is a constant considering the limiting population of n. integrating ( ) with initial conditions y( ) = y and s( ) = s gives . the maximum value of y(t) at any time t is the number of infective when y ( ) = , that is when . this is given by and this is obtained when s = n r and y = y max in equation ( ) then it follows that equation ( ) is the peak of the epidemic size. is the author/funder, who has granted medrxiv a license to display the preprint in (which was not certified by peer review) preprint the copyright holder for this this version posted september , . . https://doi.org/ . / . . . doi: medrxiv preprint to determine the final size relation of the basic reproduction number and the size of the epidemic, we take s = n and s ∞ to be a non-negative smooth decreasing function that tends to a limit as t → ∞, i.e s ∞ > . using the kermack-mckendrick model approach [ ] , let adding the first two equations and, also the first three equations of system of equations ( ), we obtain (s + e) = −σe. integrating equation ( ) on [ , ∞), we obtain integrating equation three of system equation ( ) we have and also from the first equation of system ( ) we have . cc-by-nc-nd . international license it is made available under a perpetuity. is the author/funder, who has granted medrxiv a license to display the preprint in (which was not certified by peer review) preprint the copyright holder for this this version posted september , . . https://doi.org/ . / . . . doi: medrxiv preprint therefore, integrating ( ) on [ , ∞) yields ( ) and hence substituting ( )-( ) into ( ) and simplifying yields where . therefore equation ( ) gives the final size relation with initial terms i s , e , i a , i at and j . if the initial terms are assumed to be e( ) = i a ( ) = i at ( ) = i s ( ) = j( ) = , and if a small number of infectives are introduced into the population then we have s ≈ n such that the final size relation has the form equation ( ) can be simplified further to give global stability analysis of the disease free equilibrium theorem the disease free equilibrium for models system ( ) is globally asymptotically stable provided that r < . proof in order to prove the above theorem we construct a lyapunov function as follows where a, b, c and d are defined in equation ( ). differentiating l yields is the author/funder, who has granted medrxiv a license to display the preprint in (which was not certified by peer review) preprint the copyright holder for this this version posted september , . . https://doi.org/ . / . . . doi: medrxiv preprint which simplifies to therefore expanding ( ) and simplifying with the definition of a, b, c and d in equation ( ) yields using the definition of r this further simplifies to therefore is r < , then it follows that l ≤ . it also follows that when e(t) = i a (t) = i at (t) = i s (t) = j(t) = , l ≤ and hence the largest compact invariant set is the singleton {e }. therefore by lasalle's invariance principle it follows that e is globally asymptotically stable in Ω. this completes the proof. we present simulations to assess the potential impact of isolation and mass testing on covid- by fitting the model to cumulative cases in nigeria. data on cumulative cases was obtained from official public sources from the nigeria government [ ] . our simulations will focus on two parameters γ which is the mass testing parameter and η the measures of the impact of contribution of the asymptomatic self-isolating population. the testing parameter γ assumes the values , . and . . the value zero represents absence of mass testing after day , the value . represents the baseline fitted value which we take as the base testing level by day and the value . represents an increase of testing level after day . the parameter η assumes the value . as the baseline fitted value. η = represents no transmission of covid- by self-isolating individuals after day and η = . . cc-by-nc-nd . international license it is made available under a perpetuity. is the author/funder, who has granted medrxiv a license to display the preprint in (which was not certified by peer review) preprint the copyright holder for this this version posted september , . . https://doi.org/ . / . . . doi: medrxiv preprint represents reduced transmission rate of covid- from the baseline contribution. figures , and show the model projections for covid- from day one of infection up to day . the pair (γ, η ) = ( , ) is a scenario where the mass testing is stopped and no transmission from self-isolating individuals after day and (γ, η ) = ( . , . ) is a scenario with increased mass testing and reduced transmission from self-isolating individuals after day whilst (γ, η ) = ( . , . ) is the baseline pair from data fitted to the model. figure shows the fit for cumulative cases for nigeria from day one ( ) of first infection recorded to day of recorded infections. the model fit agrees relatively to the data and hence, we use the parameter values for this fit to make the projections on the impact of mass testing and isolation in nigeria. the fitted parameter values are presented in table . figure shows the model projections for covid- daily cases for asymptotic (i a ), self-isolating (i at ), symptomatic (i s ) and symptomatic isolated (j) populations from day one of infection up to day . if mass testing were to be stopped after day , then more asymptomatic and symptomatic case would remain in the society and undetected. the increase in mass testing after day was associated with a corresponding increase in detected cases and a reduction in undetected cases. lower peaks of undetected cases were associated increase in mass testing with significant decrease in peak for symptomatic cases. figure shows model projection for covid- cumulative self-isolating, cumulative admissions from i s , cumulative admissions from i at and overall cumulative admissions for nigeria from day one of infection up to day . we observe that increasing mass testing is associated with increase in cumulative self isolation cases and as well as cumulative admissions of symptomatic cases especially from i s into monitored isolation centres. figure shows the model projections for covid- overall cumulative cases, cumulative cases from i s , cumulative cases from i at and cumulative . cc-by-nc-nd . international license it is made available under a perpetuity. is the author/funder, who has granted medrxiv a license to display the preprint in (which was not certified by peer review) preprint the copyright holder for this this version posted september , . . https://doi.org/ . / . . . doi: medrxiv preprint deaths for nigeria from day one of infection up to day . the results show that the cumulative cases will reduce with the increase in mass testing. we also note that more cases will be recorded in the monitored isolation centres. cumulative deaths will also decrease with increase in mass testing. figure shows the model projections for covid- daily cases for asymptotic, self-isolating, symptomatic and symptomatic isolated populations. the results reveal that better outcomes are achieved when there is increased mass testing and reduced transmission from those that are self-isolating. we also observe that the worst case resulted from stopping mass testing and no transmission from the self-isolating individuals. figure , shows that increasing mass testing and reducing the transmission of self-isolating individuals would initially reduce the cumulative cases but there will be a switch with the baseline scenario. in figure , the worst case which increases cumulative deaths over time is when there is no mass testing and no transmission from self-isolating individuals. we presented a mathematical model for covid- for nigeria using the cumulative cases data to calibrate the model and used the fitted parameters . cc-by-nc-nd . international license it is made available under a perpetuity. is the author/funder, who has granted medrxiv a license to display the preprint in (which was not certified by peer review) preprint the copyright holder for this this version posted september , . . https://doi.org/ . / . . . doi: medrxiv preprint as baseline parameters for model predictions. mathematical analysis was done and important thresholds for model that can be used to predict the progression or non-progression of the infection in a population. our results suggest that increase in mass testing is associated with benefits of increasing detected cases, lowering peaks of symptomatic cases, increase in self-isolating cases, decrease in cumulative deaths and decrease in admissions into monitored isolation facilities. if used in combination with monitoring the contact of self-isolating individuals, better benefits are realised when increase in mass testing is done with low transmission rate from the self-isolating individuals but the benefits are short-lived. the worst scenario comes from the case when mass testing is stopped and no transmission from the already self-isolating cases for this is associated with increase in the burden of covid- . from our results, we draw the following conclusion: mass testing is important in exposing asymptomatic cases which should self-isolate and minimize if not have zero transmission. further, the exposition of these self-isolation cases in turn is associated with lowering of peaks and less clogging of monitored isolation centres as well as the reduction of fatalities. the current mass testing levels in nigeria have not yet realised these benefits and more efforts should be invested in these strategies to help its health system to manage the worst case scenarios. lock down mea- is the author/funder, who has granted medrxiv a license to display the preprint in (which was not certified by peer review) preprint the copyright holder for this this version posted september , . . https://doi.org/ . / . . . doi: medrxiv preprint sures associated with physical distancing have been shown to delay the peaks and help systems prepare for the worst [ ] but they fall short of identifying the potential threat imposed by various infectious groups. the current study has been been able to show similar benefits as the lock down measures but more importantly the specific target groups that could be the silent drivers of infection. with the setup of most under-privileged communities in nigeria, its impossible to have zero transmission and hence, the strategy of mass testing and isolation should be complemented with other various covid- preventive, management and administrative strategies. results from this study can easily be adapted to any other country with variables similar to the modelling framework in this study. the authors declare that they have no conflict of interest. is the author/funder, who has granted medrxiv a license to display the preprint in (which was not certified by peer review) preprint the copyright holder for this this version posted september , . . https://doi.org/ . / . . . doi: medrxiv preprint is the author/funder, who has granted medrxiv a license to display the preprint in (which was not certified by peer review) preprint the copyright holder for this this version posted september , . . https://doi.org/ . / . . . doi: medrxiv preprint is the author/funder, who has granted medrxiv a license to display the preprint in (which was not certified by peer review) preprint the copyright holder for this this version posted september , . . https://doi.org/ . / . . . doi: medrxiv preprint . cc-by-nc-nd . international license it is made available under a perpetuity. is the author/funder, who has granted medrxiv a license to display the preprint in (which was not certified by peer review) preprint the copyright holder for this this version posted september , . . https://doi.org/ . / . . . doi: medrxiv preprint nigeria to ease lockdowns in major cities covid- : zoonotic aspects covid- : the case for health-care worker screening to prevent hospital transmission early estimates of epidemic 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