Estimates of exposure to coronavirus disease 2019 (COVID-19) on the African continent are limited, constrained by availability of testing and case report data. To improve understanding of COVID-19 burden, monthly severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serosurveillance was implemented at first antenatal care visits (ANC1) across six sub-Saharan African countries (Kenya, Malawi, Mozambique, Nigeria, Uganda, and Zambia). A standardized questionnaire, including COVID-19 vaccination history, was administered, and a blood sample was collected. Serology was conducted with two assays: in Nigeria, a multiplex bead-based assay targetting spike protein, receptor binding domain (RBD) 591, and nucleocapsid (N) protein and in all other countries, a SARS-CoV-2 human IgG antibody test including RBD, N protein, and hybrid RBD-N. The largest monthly change in seropositivity was between December 2021 and January 2022 for five countries (Kenya: 33.2-70.3%, Malawi: 28.3-59.6%, Mozambique: 29.3-72.8%, Nigeria: 52.4-77.4%, Uganda: 55.7-80.6%), coinciding with the Omicron wave. Aside from Mozambique, there was an increase in the proportion of women reporting COVID-19 vaccination beginning in January 2022, with highest vaccination rates between April and August 2022. Relatedly, there was an increase in the proportion vaccinated among those with detectable SARS-CoV-2 antibodies. Adenoviral vector accounted for at least half of the vaccines reported in all countries. If pregnant women are not differentially infected, ANC1 can be leveraged for serosurveillance during a pandemic. Monthly seroprevalence estimates alongside vaccination rates can provide evidence for changes in protective immunity in response to case waves and the introduction of protective measures.

BACKGROUND: Environmental cleaning is a key infection prevention and control (IPC) intervention in healthcare settings. The U.S. Centers for Disease Control and Prevention (CDC), with Infection Control Africa Network (ICAN), developed best practices for global healthcare environmental cleaning in resource-limited settings to help fill gaps in guidance in low- and middle-income countries (LMICs). We aimed to evaluate the feasibility, appropriateness, and acceptability of a quality improvement toolkit developed to assist with implementing the CDC/ICAN best practices at Lagos University Teaching Hospital in Nigeria. METHODS: A mixed-methods approach was used to evaluate the implementation of the toolkit from March through September of 2021. A monitoring checklist assessed feasibility after three defined steps within the toolkit. Key informant interviews and electronic surveys were conducted with toolkit team members at three time points during implementation to assess appropriateness and acceptability. A deductive analytic process was used to code and analyze interview data based on constructs of appropriateness and acceptability. Additional codes and sub-themes that emerged during analysis followed an inductive process. RESULTS: Within the interviews and surveys, themes identified for the appropriateness included concern related to (1) time commitment for the toolkit activities and (2) resources required to sustain improvements. Themes identified for acceptability included (1) perceived challenges with time commitment and resource requirements, (2) perceived effectiveness of toolkit structure and usability, (3) perceived benefits and success associated with knowledge gained about environmental cleaning and environmental cleaning staff, (4) perceived benefits and success associated with the training for cleaning staff undertaken during toolkit implementation, and (5) perceived benefits and success associated with the multidisciplinary team approach with the inclusion of facility leadership and a project coordinator. CONCLUSIONS: The results showed that the toolkit materials were feasible within the local context and highlighted perceived effectiveness, benefits, and success of the toolkit process and experience contributing to a high level of acceptability. Challenges relating to time commitment and concern for sustainability have implications for the appropriateness of this toolkit, similar approaches to quality improvement, and the need for strengthening support for IPC improvements at the facility and national levels in resource-limited healthcare settings in LMICs.

OBJECTIVES: To assess diagnostic mycology capacity and available fungal diagnostic services of microbiology laboratories in eight tertiary hospitals in Nigeria and one in Ghana. METHODS: On-site audits were performed in the microbiology laboratories of nine tertiary hospitals using a structured observation checklist. RESULTS: A total of nine tertiary hospitals' laboratories in Nigeria and Ghana were assessed between June 2022 and December 2023. The majority of audited laboratories lacked basic infrastructure and materials needed for fungal diagnostic testing, with less than half of the labs having a dedicated mycology bench, space or room, 3/9 (33.3%), appropriate bench workflow 1/9 (11.1%), functional biosafety cabinet type two 2/9 (22.2%), dedicated incubators 3/9 (33.3%), standard operating procedures 1/9 (11.1%), mycology atlases 2/9 (22.2%). Trained laboratory personnel for mycology were also lacking with only one of the laboratories 1/9 (11.1%) observed to have a designated trained personnel for the mycology bench. CONCLUSION: The audit revealed deficits in basic infrastructure, material resources, dedicated human resources, and laboratory capacity to detect serious fungal infections.

In recent years, there has been increased attention on the importance of healthcare environmental cleaning, including the need to professionalize and support the workforce responsible for performing cleaning. Global agendas and strategies on infection prevention and control (IPC) and water, sanitation and hygiene highlight the need for improvements to this sector, particularly in resource-limited healthcare facilities in low- and middle-income countries. Correspondingly, several resources have been developed that aim to (1) improve professional training of cleaners and (2) improve implementation of best practices in resource-limited settings. This commentary seeks to provide insight into the barriers and facilitators to implementing these resources, drawing on the practical experience from two initiatives across four countries from 2018 through 2023. Several common barriers were identified across the diverse settings, including (1) low empowerment and status of the workforce, (2) low pay, inadequate staff time for the high workload needed to achieve best practices and high turnover of staff, and (3) a lack of connection and integration of environmental cleaning with IPC and patient safety efforts at the participating hospitals. Despite barriers, local teams identified effective mitigation measures. While considerable time and effort will be needed to truly overcome these barriers, there are opportunities to build upon attention and momentum on this topic and IPC initiatives in resource-limited settings in low- and middle-income countries. We propose several broader actions, all of which require local leadership and context-specific approaches.

Environmental cleaning is essential to patient and health worker safety, yet it is a substantially neglected area in terms of knowledge, practice, and capacity-building, especially in resource-limited settings. Public health advocacy, research and investment are urgently needed to develop and implement cost-effective interventions to improve environmental cleanliness and, thus, overall healthcare quality and safety. We outline here the CLEAN Group Consensus exercise yielding twelve urgent research questions, grouped into four thematic areas: standards, system strengthening, behaviour change, and innovation.

The ongoing multi-country cholera outbreaks deserve greater attention and higher prioritisation globally.1 Since the early 1800s, there have been seven characterised global outbreaks of cholera. The seventh and current pandemic has been causing considerable illness effects since the early 1960s.2 Most recently, floods, droughts, natural disasters, and conflicts have displaced millions of people who have restricted access to clean water and live in settings with poor sewage management and increasing disease risk, further increasing the devasting effect of cholera around the globe.3 Currently, 1 billion people are at risk of contracting cholera and, concerningly, 28 countries with outbreaks in 2023, and 24 countries with active outbreaks were recorded by WHO by Sept 10, 2023 alone.4 In addition, recent outbreaks have had a high case fatality rate.5 The average cholera case fatality rate reported globally in 2021 was 1·9% (2·9% in Africa), a significant increase above the accepted target rate (<1%) and the highest recorded in over a decade.1, 5 Preliminary data suggest a similar trend for 2022 and 2023.1 Cholera is an old adversary that is both preventable and treatable.5 Despite widespread calls for strengthened pandemic preparedness and response, the global public health community are failing to apply lessons learned from COVID-19 to old challenges such as cholera. A key lesson learned from the COVID-19 pandemic is that early, rapid, and aggressive action is crucial in implementing public health interventions and countermeasure development.6

INTRODUCTION: As at 2019, Nigeria was ranked the fourth highest HIV burden in the world. There is varied geographical HIV prevalence in Nigeria. The progress made is inequitable across geographical locations and sub-populations (18). Benue state has the second highest HIV prevalence in Nigeria. In 2018, about 35,623 people living with HIV (PLHIV) were yet to commence antiretroviral treatment (ART) in the state, accounting for an estimated ART coverage gap of 11% out of the combined gap of 320,921 in the country. To close this gap, the Benue ART surge (BAS) was implemented. The aim of this study was to describe the BAS strategic approaches and demonstrate progress in expanding ART access for PLHIV in Benue State, Nigeria. METHODS: BAS was implemented in 252 health facilities from May 2019 to September 2021. Data were collected and reported using an Excel-based dashboard and electronic medical records. The trend of HIV case identification, ART initiation, viral load suppression rate, and rate of interruption in treatment during the BAS period was then described and analyzed. RESULTS: Out of 893,462 clients reached, 6.7% (n = 60,297) were diagnosed with HIV and 99.8% (n = 60,236) were initiated on ART. HIV case identification per month increased by 467% from 650 at baseline to a peak of 3685 in August 2020, and then declined by 35% to 2380 in September 2021. All new HIV-infected patients (100%) were linked to ART. Viral load testing coverage and viral load suppression rate increased from 30% (43,185/126,004) and 84% (n = 36,165/43,185) at baseline to 95% (n = 193,890/204,095) and 96% (185,785/193,890), respectively. CONCLUSION: Implementation of the BAS improved access to comprehensive HIV services in Benue State. The increase in HIV case identification and ART initiation significantly reduced the HIV treatment gap in the state. To fast track the attainment of UNAIDS 95-95-95 goals, lessons learnt from the BAS should be adapted and scaled up in the national HIV program in Nigeria.